THE ROLE OF CRITICAL THINKING SKILLS IN PRACTICING PSYCHOLOGISTS’ THEORETICAL ORIENTATION AND CHOICE OF INTERVENTION TECHNIQUES A Thesis Submitted to the Faculty of Drexel University by Ian Randolph Sharp in partial fulfillment of the requirements for the degree of Doctor of Philosophy August 2003 © Copyright 2003 Ian R. Sharp. All rights reserved. ii Acknowledgements A sincere thanks to everyone who supported me during my training and dissertation. I am forever indebted to James Herbert for his mentorship. He has prepared me well for the “real world.” With the help of his guidance and friendship, I have learned to approach the world with confidence, humility, and a healthy degree of skepticism. I owe so much thanks to Jeanie Sharp for her tireless support and encouragement. I also thank her for making so many sacrifices so that this project could be completed. Most of all, I thank her for being an amazing friend and companion. iii Table of Contents LIST OF TABLES...............................................................................................................v ABSTRACT....................................................................................................................... vi 1. INTRODUCTION ...........................................................................................................1 1.1 Is the Dodo Bird Effect Extinct?........................................................................2 1.2 The Empirically Supported Treatment Movement ............................................6 1.3 The Creation of a Task Force.............................................................................8 1.4 Innovative Therapies........................................................................................10 1.5 Eye Movement Desensitization and Reprocessing (EMDR)...........................11 1.6 Thought Field Therapy (TFT)..........................................................................12 1.7 Theoretical Orientation ...................................................................................14 1.8 Prevalence of Theoretical Orientations and Problems with Eclecticism ........15 1.9 Predicting Theoretical Orientation..................................................................17 1.10 Critical Thinking ............................................................................................22 1.11 Critical Thinking Skills ..................................................................................23 1.12 Measures of Critical Thinking Skills .............................................................24 1.13 Critical Thinking in the Health Care Professions...........................................28 1.14 Critical Thinking Skills in Professional Psychology......................................29 1.15 Heuristics and Biases......................................................................................30 2. METHOD ......................................................................................................................33 2.1Participants .......................................................................................................33 2.2 Procedure .........................................................................................................34 iv 2.3 Instrumentation ................................................................................................35 2.4 Principal Hypotheses .......................................................................................38 3. RESULTS ......................................................................................................................39 3.1 Demographics ..................................................................................................40 3.2 Critical Thinking Questionnaire (CTQ) ..........................................................43 3.3 Treatment Approaches and Techniques Questionnaire (TATQ) ....................49 3.4 Multiple Regression Analyses .........................................................................53 4. DISCUSSION ................................................................................................................55 4.1 Hypotheses.......................................................................................................56 4.2 Popularity of Therapies ...................................................................................58 4.3 Study Limitations and Recommendations for Future Research ......................62 REFERENCES ..................................................................................................................63 APPENDIX A: Demographic Information........................................................................74 APPENDIX B: CTQ ..........................................................................................................75 APPENDIX C: Critical Thinking Questionnaire (CTQ) Item Sources .............................80 APPENDIX D: Treatment Approaches and Techniques Questionnaire (TATQ) .............81 APPENDIX E: TATQ Items..............................................................................................82 VITA ..................................................................................................................................83 v LIST OF TABLES 1. Demographics of Study Sample and 2000 APA Membership Survey Data .....................41 2. Rank Orders of Theoretical Orientation ...........................................................................44 3. CTQ Items .........................................................................................................................45 4. CTQ Subscale Scores and Means .....................................................................................48 5. TATQ Item Frequencies ...................................................................................................50 6. Rotated Component Matrix with Item Loadings ..............................................................51 vi ABSTRACT The Role Of Critical Thinking Skills In Practicing Psychologists’ Theoretical Orientation and Choice of Intervention Techniques Ian Randolph Sharp James D. Herbert, Ph.D. Over the past two decades, professional psychology has witnessed a growing movement towards the utilization of psychotherapies that have empirical support. Despite this development, therapies that have not been empirically supported continue to experience widespread use. Concurrently, a collection of novel interventions, known as Power/Energy therapies (P/ET’s), has emerged. Although these therapies are based on questionable theoretical foundations and enjoy little or no empirical support, their popularity with clinicians appears to be strong and growing. There is scant research examining individual differences with respect to the practice habits of professional psychologists. The present study examined whether critical thinking skills are a factor in psychologists’ choice of therapeutic interventions, including their use of P/ET’s. As hypothesized, participants who reported using a number of techniques from Power and Energy therapies scored significantly lower on a measure of critical thinking skills. Also as hypothesized, individuals who reported using a number of cognitive-behavioral techniques scored significantly higher on the measure of critical thinking skills. Implications and suggestions for future research are discussed. 1 Up until the1950’s, what little empirical research there was on psychotherapy largely focused on process. Pioneers like Carl Rogers examined what happened in therapy sessions and how the behavior of clients and therapists affected the selfunderstanding and insight of the clients. For example, Rogers argued that being genuine with the client and showing unconditional positive regard were essential ingredients of the therapeutic process and led to client improvement (Rogers, 1957). Few questioned the overall effectiveness of psychotherapy. In 1952, Hans Eysenck altered this focus on process by calling into question the effectiveness of psychotherapy. Eysenck published a seminal review article that concluded that “neurotics” who received psychotherapy essentially mirrored those who did not in terms of improvement (Eysenck, 1952, 1992). He concluded that psychotherapy had failed to demonstrate effectiveness. He further concluded that the lack of scientific evidence for the effectiveness of psychotherapy called into question its use until such evidence was demonstrated. Eysenck’s conclusions galvanized psychotherapy research and its change in focus from process to outcome; studying the components of therapy was potentially obviated by the potential that therapy simply did not work (Hill & Corbett, 1993). Since Eysenck's early warnings of the potential lack of effectiveness of psychotherapy, a tremendous body of research has accumulated showing that psychotherapy does generally work (see Hunsley & DiGiulio, 2002 for a recent review). In 1967, Gordon Paul reviewed the psychotherapy literature and concluded that the greatest need was for outcome research. His frequently quoted question set the stage for treatment outcome research: "What treatment, by whom, is most 2 effective for this individual with that specific problem, and under which set of circumstances?" (Paul, 1967, p. 111). With the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) treatment outcome research was now able to focus on interventions for relatively clearly defined disorders. Prior treatment research had focused on nebulous conditions and patient populations (e.g., “neurotics”) but could be now informed by operationally defined syndromes. Similarly, the delineation of treatments themselves would provide the same control for research. Thus, treatment manuals provided a more valid and reliable way of testing the efficacy of a particular treatment. Beck et al.’s Cognitive Therapy for Depression was one of the first in a line of treatment manuals that had demonstrated efficacy (Beck et al., 1979). Empirically supported treatment (EST) manuals have since been developed for a wide range of problems, from Irritable Bowel Syndrome to Schizophrenia. Despite the strong response to Paul’s appeal to focus on outcome research and the subsequent robust findings of the effectiveness of psychotherapy, a persistent movement has pervaded psychotherapy research. The proponents of this movement have argued that although psychotherapy in general is effective, there is no specificity in terms of specific interventions for specific problems. In other words, the various orientations and approaches to psychotherapy are simply variations on a theme and the distinctions between them are meaningless with respect to treatment outcome. 1.1 Is the Dodo Bird Effect Extinct? In 1936, Rosenzweig quoted the Dodo bird from Alice in Wonderland to make a point that psychotherapies are effective because of shared factors, “Everyone 3 has won, and all must have prizes” (Carroll, 1865/1962). This notion that all psychotherapies are equally effective has come to be known as the Dodo bird effect. Luborsky, Singer, & Luborsky (1975) published an influential paper that reviewed the extant psychotherapy outcome literature at that time and concluded that all psychotherapies had roughly equivalent efficacies, thereby lending support to the Dodo bird effect (Luborsky, Singer, & Luborsky, 1975). Another influential study by Smith, Glass, and Miller also found psychotherapy was effective in general and that no one treatment was superior to another (Smith, Glass, and Miller, 1980). The most frequently used analytical tool in defense of the Dodo bird effect has been the meta-analysis (e.g., Smith, Glass, and Miller, 1980). Utilizing metaanalysis, a number of more recent studies appear to confirm the Dodo bird hypothesis. For example, Wampold et al. (1997) conclude from their meta-analysis of psychotherapy outcome studies that treatment effects are roughly equivalent across approaches, though they caution that it is cannot be said that all therapies are equivalent across specific disorders. They conclude their paper with, “Why is it that researchers persist in attempts to find treatment differences, when they know that these effects are small in comparison to other effects, such as therapists effects … or effects of treatment versus no-treatment comparisons?” (Wampold et al., 1997, p. 210). Other studies, however, have raised questions about the Dodo bird effect. For example, Dobson (1989) conducted a meta-analysis comparing cognitive therapy for depression to a number of other standard treatments including pharmacotherapy and other psychotherapies. Dobson concluded that cognitive therapy was superior to any 4 other treatment for depression (Dobson, 1989). Wampold et al.’s (1997) metaanalysis found that when comparing effect sizes across a number of disparate studies one could argue that most psychotherapies were equivalent. Dobson’s meta-analysis examined treatments for a specific disorder and in doing so the Dodo bird effect disappeared. The use of meta-analysis is not without controversy itself. Arguments have been made that meta-analysis can be used to confirm a priori hypotheses. Some have confirmed the Dodo bird effect by performing meta-analyses of meta-analyses (Lipsey & Wilson, 1993), which prompted Hans Eysenck to respond: A method that averages apples, lice, and killer whales (here psychological, educational, and behavioral treatments) can hardly command scientific respect; there is little in common among psychotherapy for bulimia, cognitive behavioral therapy with dysfunctional children, parent effectiveness training, diversion programs for juvenile delinquents, effects of hypnosis on anxiety, group assertion training, career education programs, social skills training, preoperative preparation of children for surgery, biofeedback for migraine, music therapy for pain reduction, adolescent pregnancy programs, behavioral treatment for obesity, the Feingold diet for hyperactivity, computer-aided instruction, interactive video instruction, cooperative learning, positive reinforcement in the classroom, enrichment programs, coaching for Scholastic Aptitude Tests, creativity training techniques, Frostig visual perception training, language intervention, science in-service training, career development courses, and mass media campaigns. To combine the outcomes of all these (and many more) meta-analyses seems to me a gigantic absurdity (Eysenck, 1995; see also Eysenck, 1994 for a critique of meta-analysis). Other critics have argued that the Dodo bird effect found via many published metaanalyses may be strongly influenced by other factors including unaccounted for mediator and moderator variables (Shadish & Sweeney, 1991), or by inappropriate 5 treatment comparisons (Crits-Cristoph, 1997). Shadish and Sweeney (1991) argued that therapy orientation does make a significant contribution to outcome through mediating and moderating effects and that the Dodo bird effect is simply an artifact of the failure to look for these effects (Shadish & Sweeney, 1991). They found that mediator variables, such as level of standardization and implementation of treatment in a study, and moderator variables, such as conducting a study in a university setting, influenced outcome (Shadish & Sweeney, 1991). Critics of the early meta-analyses (such as the classic Smith et al., 1980, study) assert that many of the studies used in the analyses were conducted with participants who were not being treated for clinical problems. For the studies that did focus on clinical problems, many of them were conducted prior to the publication of the DSM-III (American Psychiatric Association, 1980), a watershed in the classification of psychological disorders. Lastly, critics stress that the establishment of treatment manuals has revolutionized outcome research, something not accounted for in the early meta-analyses (Task Force on Promotion and Dissemination of Psychological Procedures [Task Force], 1995). The Dodo bird controversy had the effect of convincing some to accept that something about psychotherapy in general is effective, and that exploration and integration of so-called “common factors” shared by most forms of psychotherapy would be the most beneficial direction for the field. In fact, this interest in common factors has lead to the development of organizations devoted to the study and promotion of psychotherapy integration (e.g., Society for the Exploration of Psychotherapy Integration). Others have concluded that although we now know that psychotherapy is generally effective, we should continue to heed Paul’s call to arms 6 and focus on efficacy and effectiveness in outcome research for specific interventions targeting specific problems. 1.2 The Empirically Supported Treatment (EST) Movement As discussed above, over the past two decades treatment outcome research has produced treatment manuals with demonstrated efficacy for a wide range of problems. These empirically evaluated treatments have largely been developed and tested by academics in clinical laboratory settings. This has spawned a debate over the generalizability of efficacy research and a call by some for more effectiveness research (e.g., Seligman, 1995). After the publication of a survey of its readers’ experiences with mental health services in Consumer Reports (1995), Martin Seligman (who was involved with the development and implementation of the survey) became a strong proponent of moving treatment outcome research from a focus on efficacy (outcome studies under tightly controlled conditions using clearly defined treatments with clearly defined population) to a focus on effectiveness (outcome studies under loose, more “real-world” conditions). Seligman contended, “the efficacy study is the wrong method for empirically validating psychotherapy as it is actually done, because it omits too many crucial elements of what is done in the field” (Seligman, 1995, p. 968). Seligman’s conclusions have been met with skepticism by many in the academy, however, as illustrated by the following quotation from leading psychotherapy researchers: If the field of psychotherapy research were to adopt Seligman’s (1995) recommendation uncritically and accept uncontrolled, self-selected consumer surveys–or anything less than the most rigorous scientific standards–as a model for determining the benefits of treatments, it 7 would be taking a giant step away from the rest of medical research and its staggeringly impressive accomplishments (Mintz, Drake, & Crits-Cristoph, 1995). David Barlow (1996) summarized some of the objections to efficacy research. He stated that one area of objection surrounds the notion that current applications of the scientific method are inappropriate for psychotherapy research. Further, arguments generally include the question of the adequacy or inadequacy of specific philosophies of science that are applied in psychotherapy research. Barlow argued that one of the major current factors in the push for empirical support for psychological interventions is the demand being placed on health care professionals by government agencies and healthcare policymakers to provide evidence that their treatments work. Thus, external pressure to demonstrate efficacy supplants the field’s desire for philosophical debate. Another area of objection Barlow outlined involves questions raised by applying highly structured research results and treatment manuals to frontline clinical settings. Further, some argue that it is premature to identify certain treatments as effective when it is unclear why they are effective (Barlow, 1996). In other words, some argue that the active ingredients are inherent to all psychotherapy, not something special about specific circumscribed treatments (a rehashing of the Dodo bird argument). For example, Frank & Frank (1991) argued that common factors such as the therapeutic relationship, setting, and rationale for therapy are at the core of behavioral change. It should also be noted that some in the field have called for an increase in “softer” research methodologies like clinical case studies and selfexperimentation to augment “practicing knowledge” (Howard, 1993). 8 1.3 The Creation of a Task Force Cohen, Sargent, and Sechrest (1986) published an investigation of professional psychologists’ utilization of psychotherapy research in the American Psychologist. They found that 27% reported that empirical research had no discernible impact on their clinical practice. Hence, based on their data, more than a quarter of psychologists rely solely on other sources to inform their clinical work. It is unclear to what extent empirical research plays a role in informing current practicing psychologists’ choice of interventions. Psychotherapy outcome researchers report growing frustration with the science-practice gap, while front-line clinicians suffer from little time to wade through the morass of often-conflicting research, not to mention the possible need for retraining. In part to address this science-practice gap, a Task Force on Promotion and Dissemination of Psychological Procedures was created within Division 12 (Clinical Psychology) of the American Psychological Association. They issued a report in 1995 as “a response to intense social, economic, and political forces that demanded to know which of the 400-plus psychotherapies were effective” (Beutler, 1998). The Division 12 report (Task Force, 1995) was an attempt to provide a blueprint for what treatments have been shown to be efficacious with what problems. The group described the rationale for the development of a Task Force and their report: This task force was constituted to consider methods for educating clinical psychologists, third party payers, and the public about effective psychotherapies. Lacking the enormous promotional budgets and sales staff of pharmaceutical companies, clinical psychologists labor at a disadvantage to disseminate important findings about innovations in psychological procedures. Despite the great strides in the development and validation of effective 9 treatments, it is not clear that the benefit of our approaches is widely appreciated, even by other clinical psychologists (Task Force, 1995, p. 3). The work of the Task force has sparked significant controversy and debate, and has brought to the forefront a variety of issues. For example, epistemological disagreement on the question of determining what works (e.g., empirical evaluation vs. clinical experience) is likely the nucleus of the debate. In addition to the previously mentioned criticism of efficacy research, the use of practice guidelines and treatment manuals are viewed by some clinicians as overly constraining due to being limited to particular therapeutic approaches. Further, some argue that disorderfocused practice guidelines and treatment manuals oversimplify the complex nature of clients seen outside of treatment research. Further, the criteria for defining “empirical support” have generated considerable debate (Herbert, 2000). Several psychology journals have devoted special issues to this topic (e.g., Herbert, 2003). In light of this controversy, it remains unclear to what degree clinical practice has been affected by this push towards the use of empirically validated interventions. In addition to the numerous new treatments being developed and tested for specific disorders, traditional, non-empirically supported psychotherapies (e.g., psychoanalytic psychotherapy) continue in wide popularity. Moreover, novel treatments continue to be developed at a relatively rapid rate. Practicing clinicians generally develop these treatments, most with little regard for current psychotherapy theory and with little emphasis on scientific evaluation. Thus, treatment approaches that have not undergone rigorous empirical evaluation enjoy widespread use. Many clinicians often use the aforementioned argument that psychotherapy, and what is 10 effective about it, cannot be captured in a laboratory setting, thereby rendering useless the findings of psychotherapy research. 1.4 Innovative Therapies Complementary and Alternative Medicine (CAM) includes such a variety of theoretical frameworks and treatments that it is difficult to define. Generally, CAM includes therapies that have been developed outside of the realm of mainstream science, that incorporate religious or spiritual ideas, and that have not been subjected to rigorous empirical validation. As medicine has witnessed a boon in CAM, so has mental health practice. For example, in a recent article in the APA journal Professional Psychology: Research and Practice, White (2000) recommends that professional psychologists integrate CAM into their practices. Citing her advanced training in Oriental medicine and homeopathy, White provides a blueprint for how CAM can be incorporated into private practice as “integrative medical psychology.” She describes her own such practice as including offices dedicated to acupuncture and natural medicine as well as an herbal apothecary, all in addition to her psychotherapy room. Interlaced with CAM, new forms of psychotherapy seem to mushroom in the field of mental health treatment on an almost daily basis. Often labeled as “innovative” or “cutting-edge,” these approaches generally do not follow the standard path of theoretical development, empirical evaluation, and dissemination through publication in peer-reviewed journals. Instead, these techniques are frequently developed based on clinical observation, supported using anecdotal evidence and 11 testimonials, and promoted through workshops, training media (i.e., audio- and videotapes, books), and increasingly through websites on the Internet. Over the past decade the most popular and widely utilized genre of “innovative” techniques has been the Power/Energy Therapies (P/ET’s). Power therapies are so-called because practitioners and promoters argue that they are significantly more powerful and rapid than traditional treatment approaches (Commons, 2000). The energy therapies are so-called because they generally incorporate traditional Eastern philosophies about energy systems in the body. They are typically lumped together because most energy therapies are considered power therapies; on the other hand not all power therapies are considered energy therapies as in the case of Eye Movement Desensitization and Reprocessing (EMDR; Shapiro, 1995). Some examples of the P/ET’s, in addition to EMDR, include Thought Field Therapy (TFT; Callahan, 1985), Emotional Freedom Techniques (EFT; Craig, 2001), Visio/Kinesthetic Dissociation (V/KD; Bandler, 1985), Traumatic Incident Reduction (TIR; Gerbode, 1995), Touch and Breathe (TAB; Diepold, 2000), Be Set Free Fast (BSFF; Nims, 2001), Tapas Acupressure Technique (TAT; Fleming, 1999), and Emotional Diagnostic and Treatment Methods (EdxTM; Gallo, 2000). This is not an exhaustive list. A thorough overview of each of the many P/ET’s is beyond the scope of this paper. However, the two most archetypal representations of P/ET’s, and almost certainly the currently most popular, will be discussed: EMDR and TFT. 1.5 Eye Movement Desensitization and Reprocessing (EMDR) Developed by clinical psychologist Francine Shapiro, EMDR is arguably the most popular and controversial of the Power/Energy therapies. EMDR is based on a 12 rather crude theory that emotional disturbances become “trapped” in the brain and that different forms of stimulation, like side-to-side eye movements, provoke the brain’s “information-processing system,” thereby allowing the brain to heal. The EMDR Institute website claims that since its development in 1987, over 50,000 licensed mental health professionals have been trained in EMDR and that EMDR has “successfully helped over a million individuals” (EMDRIA, 2003). EMDR also distinguishes itself from the rest of the P/ET’s, as there is a substantial body of research investigating its effects. EMDR has not been demonstrated to be superior to extant treatments for emotional trauma and has in some cases been shown to be inferior (Herbert et al., 2000; Davidson & Parker, 2001; Devilly, 2002). Critics of EMDR have argued that the eye movements are superfluous to any observed treatment effects (Lohr, Tolin, Lilienfeld, 1998) and therefore because of the similarities with standard cognitive behavioral techniques “what is effective in EMDR is not new, and what is new is not effective” (Rosen, Lohr, McNally, & Herbert, 1999, p.10). Although EMDR was created as a treatment for emotional trauma, proponents have applied it to a wide variety of problems. Further, critics argue that the popularity of EMDR has far surpassed the empirical evidence supporting it (Herbert et al., 2000; Herbert, in press). 1.6 Thought Field Therapy (TFT) As EMDR is the standout of the broad category of Power therapies, TFT is the prototype of the subcategory of Energy therapies. Developed and promoted by psychologist Roger Callahan, TFT is based on the notion that the human body possesses invisible energy fields called “thought fields.” Psychological distress is the 13 result of disruptions -- what Callahan has termed “perturbations” -- occurring in the flow of these energy fields. These energy flow disruptions are treated by physically tapping on “energy meridian” points in specific patterns (“algorithms”) specific to the presenting problem, while thinking about the traumatic event or negative feelings. Thus, “when applied to problems TFT addresses their fundamental causes, balancing the body's energy system and allowing you to eliminate most negative emotions within minutes and promote the body's own healing ability” (TFTRX, 2001). Proponents consistently assert that TFT is able to “cure” myriad problems; “it gives immediate relief for PTSD, addictions, phobias, fears and anxieties” (Thought Field Therapy Training Center of La Jolla, 2001). Despite proponents’ extraordinary claims, critics note that there is no compelling empirical evidence that TFT is effective for any psychological problems. Further, the purported theoretical foundation for TFT is “grounded in unsupported and discredited concepts” (Gaudiano & Herbert, 2000). Several of the other PE/T’s are offshoots of TFT, often based on the same theoretical underpinnings and/or developed by individuals trained in TFT. This includes EFT, which in turn is incorporated into other P/ET’s like GTT and WLH. One likely reason for the popularity of P/ET’s is that they are aggressively and effectively marketed directly to clinicians, while EST’s are disseminated through the often-glacial peer-review process into a multitude of scientific journals. In competition with one another, advances made in EST’s appear to be frequently overshadowed by the promotional savvy of the supporters of the P/ET’s. A typical marketing technique of many if not most of the P/ET’s is to provide a certification 14 program in which individuals pay money to receive training. These individuals are then certified in this treatment approach, receive a handsome diploma, and are able to add concocted strings of letters to the end of their names. This process leads the public to think that these certifications were provided by a higher, socially approved agency (Singer & Lalich, 1996). As previously mentioned, the P/ET’s are not without critics. Behavior therapy pioneer Arnold Lazarus opined on the current state of psychotherapy (2000): The most unfortunate development, in my opinion, is the vast augmentation of New Age Therapists who adhere to mystical and transpersonal philosophies. Added to this are the socalled Power Therapies that have attracted militant adherents (such as the promulgators of Thought Field Therapy whose basic assumptions rely on energy fields that have no scientific validity)” (p.154). Critic Tana Dineen argued that professional psychology is taking on many of the characteristics of a religion evidenced by “the adoption of Eastern mystical and Native American approaches as healing techniques in psychotherapy” and the “the acceptance of spiritual, transcendental, and supernatural concepts into the language of psychotherapy” (Dineen, 1998). Although it is currently unclear to what magnitude P/ET’s are utilized by psychologists, there is little doubt that their rate of growth is increasing rapidly. The tension between scientific and non-scientific approaches to psychotherapy and the rise of P/ET’s may be better understood in the context of theoretical orientation. 1.7 Theoretical Orientation There is much overlap between theoretical orientation and practical orientation. The meaning of the term “theoretical orientation” can range from very 15 abstract philosophical positions on ontology and epistemology to very concrete definitions that describe clinicians’ day-to-day practical interaction with clients. In other words, theoretical orientation in one instance may refer to someone’s general worldview about the nature of psychopathology and its manifestations. In another instance it may reflect whether someone chooses supportive listening versus systematic desensitization to treat individuals with phobias. This broad range is reflected in the literature. This range is a reflection of the continuum of specificity, rather than a natural dichotomy. The present study will focus more on the topographical features of orientation than the philosophical features. This study will continue the tradition of using the term theoretical orientation, with a potentially more accurate term for the focus of this study being practical orientation. But it is first necessary to provide a brief overview of the previous research on theoretical orientation. 1.8 Prevalence of Theoretical Orientations and Problems with Eclecticism A number of studies have attempted to estimate the popularity of various theoretical orientations among professional psychologists. For example, Jensen, Bergin, & Greaves (1990) found that 70% of clinical psychologists surveyed reported being “eclectic” in their theoretical orientation. They also provided an overview of similar survey research conducted previously and found that their sample was the highest percentage reporting an “eclectic” orientation to date. They broke down the eclectic group further by having those that identified themselves as eclectic list combinations of orientations. The top four theoretical preferences among those that 16 referred to themselves as eclectic were: cognitive (63%), dynamic (62%), behavioral (56%), and humanistic (32%) (Jensen, Bergin, & Greaves (1990). Milan, Montgomery, & Rogers (1994) attempted to conduct an empirical investigation of various claims that had been made regarding paradigmatic shifts and trends (e.g., the growth of eclecticism, the decline of behaviorism, a resurgence of psychoanalysis). The results of their data analyses demonstrated some weak trends in theoretical orientation in the decade of the 1980’s. Their general conclusion was that there was some growth in the cognitive perspective while behavioral, interpersonal, and psychoanalytic orientations all remained strong, but there was mostly little change when measured from the beginning to the end of the decade. They also found that the most common theoretical orientation the respondents endorsed was “eclectic” with 43.3, 42.7, and 39.1 percent of respondents endorsing this as their primary theoretical orientation from years 1981, 1985, and 1989, respectively. All of their data were obtained from the National Register of Health Service Providers in Psychology from 1981, 1985, and 1989 (Council for the National Register of Health Service Providers in Psychology, 1981; 1985; 1989). A clear problem with prior research investigating theoretical orientation has been the label eclectic. Lazarus and Beutler (1993) provide an overview of the two main eclectic camps. They describe “unsystematic eclectics” and “theoretical integrationists” as those who attempt to blend the various components of theories into a coherent whole. They describe “technical eclectics” as those who “select procedures from different sources without necessarily subscribing to the theories that spawned them… Hence, they borrow techniques from other orientations, based on the 17 proven worth of these procedures” (Lazarus & Beutler, 1993). Thus, in keeping with the EST movement, technical eclectics provide therapeutic techniques with empirical support whereas unsystematic eclectics and theoretical integrationists are more interested in the integration of different schools at a theoretical level. Although different definitions exist, previous research focusing on theoretical orientation has failed to distinguish theoretical and technical eclecticism. In other words, previous research with those describing themselves as eclectic focused on what theories clinicians’ subscribe to and not what techniques they utilize. The present study will attempt to resolve this issue by distinguishing between and addressing both theoretical and technical eclecticism. 1.9 Predicting Theoretical Orientation Previous research has attempted to elucidate some of the factors associated with theoretical orientation. This section will summarize some of the research focusing on both psychology graduate students and practicing psychologists. Graduate Training. Perhaps the most obvious predictor of a psychologist’s theoretical orientation would be what they learned in graduate school. However, in a sample of professional psychologists the theoretical orientation of their most influential mentor in graduate school was compared to their own current theoretical orientation. This demonstrated only moderate correlation. Further, more than half of professional psychologists surveyed reported a different theoretical orientation than their former professors (Sammons & Gravitz, 1990). Self-Monitoring. This study found that using a standard measure of selfmonitoring (i.e., one’s ability to adjust one’s behavior in response to external cues), 18 high self-monitors (i.e., those better able to adjust their behavior to people and situations) were more eclectic than low self-monitors and that those frequently using more than one orientation had higher self-monitoring scores. Furthermore, selfmonitoring correlated negatively with psychoanalytic endorsement, but in a positive direction with behavioral, systems and eclectic endorsements. It should be noted that the sample used in this study consisted of intake interviewers in a child guidance center with education level ranging from a bachelors to a doctorate degree (Mathews & Marshall, 1988). Mental Health Values. Jensen & Bergen (1988), using a mail survey, examined clinicians’ “mental health values themes” and found an effect for theoretical orientation. Participants rated these themes, which were made up of statements like “Develop effective strategies to cope with stress” and “Be open, genuine, and honest with others”, on a Likert scale of how important they felt they were for the maintenance of a positive, healthy lifestyle. Themes that were associated with theoretical orientation included a forgiveness theme “Forgive others who have inflicted disturbance in oneself” and “Make restitution for one’s negative influence.” They found that those who described themselves as psychodynamic agreed less strongly with this theme than did systems, behavioral, or eclectic clinicians. They also found that behavioral and systems-oriented therapists expressed lower agreement than psychodynamic and eclectic therapists with the self awareness/growth theme (e.g., Become aware of inner potential and ability to grow; Discipline oneself for the sake of growth) (Jensen & Bergen, 1988). Their sample included psychologists, psychiatrists, marriage and family therapists, and social workers. 19 Ethical Decision Making Skills. Haas, Malouf, & Mayerson (1988) examined ethical decision making skills in psychologists. They sent out surveys that featured 10 clinical case vignettes that presented ethical dilemmas. They did not find any meaningful differences across theoretical orientations. However, the study employed a limited, forced choice for theoretical orientation (Haas, Malouf, & Mayerson, 1988). Clinical vs. Counseling Psychologists. Zook and Walton (1989) attempted to address the recent debate in the literature involving proposals by some (e.g., Levy, 1984) that because there is so much overlap between clinical, counseling, and school psychology that they be merged into a broader "human services psychology." Zook and Walton conducted a survey of clinical and counseling psychologists examining theoretical orientation and work place setting. Theoretical orientation was broken down into three main categories based on participant’s responses: psychodynamic (dynamic and analytic), humanistic (existential, gestalt, person-centered, transactional-analysis), and behavioral (cognitive-behavioral, behavioral, rationalemotive). Seventy-five percent of the sample chose more than one orientation. Grouping counseling and clinical psychologists together, 24.2% fell into the psychodynamic category, 29% in the humanistic category, and 36.8% in the behavioral category. The three most endorsed orientations when including the subcategories were cognitive-behavioral (20.2%), humanistic (18.5%), and psychodynamic (18%). They also found that younger clinical psychologists tended not to favor the psychodynamic orientation, leading the authors to conclude that 20 either these individuals will later come to embrace the orientation or that there is a move away from it (Zook & Walton, 1989). Another survey study of clinical and counseling psychologists conducted by Johnson and Brems (1991) attempted to address some of the shortcomings of the Zook and Walton (1989) study, namely the non-objective measure of theoretical orientation. To speak to this, they employed the Theoretical Orientation Scale (TOS; Coan, 1979). The TOS is a 63-item instrument where respondents select from a 5point Likert scale (1= strongly disagree to 5 = strongly agree). The items are drawn from eight primary factors that tap theoretical content such as behavioral versus experiential content emphasis and impersonal causality versus personal will. One major problem with the TOS is that it provides little information about what specific interventions clinicians employ. Hence, it provides information about more abstract theoretical orientation but not practical orientation. The study found no difference between counseling and clinical psychologists using the TOS. Family of Origin. In their survey of psychologists, Johnson, Campbell, & Masters (1992) found that several family of origin characteristics demonstrated weak correlation with theoretical orientation as measured by the Theoretical Orientation Survey (TOS). Range of feelings, empathy, and openness to others were the item areas that were found to have the strongest relationship with theoretical orientation. It is important to note that theoretical orientation in this study is defined by the TOS and not by a specific treatment approach (Johnson, Campbell, & Masters, 1992). Personality Factors. Utilizing an assessment of the Five-Factor Model of personality, Scandell, Wlazelek, & Scandell (1997) examined personality factors and 21 theoretical orientation. Theoretical orientation was measured by asking the participants to rate their belief in and adherence to a list of common orientations. They found that the cognitive orientation was positively correlated with the agreeableness domain and the related facets of straightforwardness and altruism. Humanistic orientation was correlated with openness to fantasy and openness to action. The Gestalt orientation was correlated with openness to fantasy (Scandell, Wlazelek, & Scandell, 1997). This study was hampered by a number of major methodological problems, however, including basing results on a small convenience sample. In summary, a number of studies have attempted to explain factors that contribute to clinicians’ theoretical orientation. However, this research has failed to provide a complete picture of the factors that contribute to the development of theoretical orientation. Further, no research has examined theoretical orientation when it is defined as the specific treatments clinicians’ employ. With the movement towards empirically supported treatments coinciding with a rise in questionable Power and Energy therapies, we know very little about factors that lead some clinicians to chose EST’s and some to chose PE/T’s or other interventions lacking empirical support. Critical thinking skills may be a factor when clinicians’ are faced with making a decision about what treatments they will use. For example, it is possible that an individual who is strong in evaluating arguments (a critical thinking skill) is less likely to accept anecdotal evidence as supportive of a novel psychotherapy. 22 1.10 Critical Thinking Critical thinking can be difficult to define operationally. Many definitions of critical thinking have been suggested with these definitions being informed from education, philosophy, and psychology (Sormunen & Chalupa, 1994). However, there are important themes running through most accepted definitions. For the purposes of this study we will adopt the definition of critical thinking from Levy (1997): “an active and systematic cognitive strategy to examine, evaluate, and understand events, solve problems, and make decisions on the basis of sound reasoning and valid evidence” (p. 236). Additionally, Klaczynski, Gordon, and Fauth (1997) submit that many in the field view critical thinking as being composed of two factors. The first factor is the ability that is principally reflected in the above definition of critical thinking. This factor represents competency in actively performing a cognitive process (e.g., problem solving). The second factor involves the metacognitive process of evaluating evidence that may challenge one’s beliefs or goals (Klaczynski, Gordon, & Fauth, 1997). In other words, a critical thinker is able to evaluate the influence that their existing beliefs have on their ability to reason. Further, they are able to partial out the influence of their beliefs on their ability to think critically. In summary, a critical thinker not only possesses the appropriate skills to think critically, they possess the knowledge and ability to use them in varying conditions (e.g., when evidence conflicts with held beliefs). 23 1.11 Critical Thinking Skills Halpern (1998) proposed a helpful taxonomy of critical thinking skills that includes the following areas: (a) verbal reasoning skills. These include skills that one uses to comprehend and defend against persuasive techniques that are embedded in language; (b) argument analysis skills. An argument is a set of statements with at least one conclusion and one reason that supports this conclusion. In real life, arguments are often complex, with reasons that run counter to the conclusion, stated and unstated assumptions, irrelevant information, and intermediate steps; (c) skills in thinking as hypothesis testing. People function like intuitive scientists to explain, predict, and control events. These skills include generalizability, recognition of the need for an adequately large sample sizes, and validity; (d) likelihood and uncertainty. Because very few events in life can be known with certainty, decisions should be informed with the correct use of cumulative, exclusive, and contingent probabilities; (e) decision-making and problem-solving skills. Generally, all critical thinking skills are used to make decisions and solve problems, but the skills included in this category involve generating and selecting alternatives and judging among them. Creative thinking skills are subsumed under this category. Halpern suggests that collectively these five categories, sometimes referred to as macroabilities, represent a working model of the skills approach to critical thinking (Halpern, 1998). Halpern’s model of the skills approach to critical thinking is structured in part to be used for the teaching of these skills (Halpern, 1998). 24 1.12 Measures of Critical Thinking Skills There are a number of instruments that have been developed to measure critical thinking skills. Two of the most widely used and studied instruments are the Watson-Glaser Critical Thinking Appraisal (WGCTA; Watson & Glaser, 1980) and the Cornell Critical Thinking Test (CCTT; Ennis, Millman, & Tomko, 1985). Consistent with Halpern’s general critical thinking skills taxonomy (1998), the WGCTA and CCTT pinpoint specific skill areas. Although there is not a direct oneto-one correspondence between the specific subscales of the WGCTA and the CCTT, the subscales do appear to tap very similar skill domains. Moreover, both scales are generally consistent with Halpern’s model. Although measures of critical thinking correlate with a number of other psychological constructs (e.g., IQ), they appear to represent a distinct (Watson & Glaser, 1994) yet heterogeneous construct (Ennis, Millman, & Tomko, 1985). For example, significant correlations have been identified between the WGCTA and the Otis-Lennon Mental Ability Tests-Gamma (r=.60) and the WGCTA and the Wechsler Adult Intelligence Scale-Verbal (r=.55). Based on these correlations, the WGCTA appears to tap a construct that is related to but not fully accounted for by general intellectual ability as measured by standard intellectual measures (Watson & Glaser, 1994). The Watson-Glaser Critical Thinking Appraisal (WGCTA). The WatsonGlaser Critical Thinking Appraisal (WGCTA) is a widely used measure with wellestablished psychometric properties. The WGCTA has three separate forms; A, B, and S. Forms A and B (WGCTA-A; WGCTA-B; Watson & Glaser, 1980) were the earliest manifestations of the test and feature the same number of items and the same 25 5 subareas. The two forms are frequently used as a pretest and posttest to prevent possible practice effects if the same test is administered twice. Form S (WGCTA-S; Watson & Glaser, 1994) is a newer short version of form A. Form S maintains the same format as form A but has had the number of questions reduced by half to allow for the test to be administered in half the time. All three tests are appropriate for individuals with at least a ninth-grade education (Watson & Glaser, 1994). In an evaluation of the psychometric properties of Form S, Loo and Thorpe (1999) identified several problems including poor recovery of the five subtests in factor analyses and low internal-consistency reliabilities for the scores on the five subscales. However, they found the test to be free of gender effects, and recommended its use (Loo & Thorpe, 1999). The WGCTA is based on abilities originally identified by Dressel and Mayhew (1954): (a) definition of a problem, (b) selection of significant information for the solution of a problem, (c) recognition of assumptions (stated or not stated), (d) formulation and selection of hypotheses, (e) validation of conclusions, and (f) judgment of inferences (Dressel & Mayhew, 1954). Based on these abilities, the WGCTA is designed to measure five subareas of critical thinking that, as a composite, provide an overall assessment of critical thinking ability. The first area is inference, which is defined as “discriminating among degrees of truth or falsity of inferences drawn from given data.” The second area is recognition of assumptions, which is defined as “recognizing unstated assumptions or presuppositions in given statements or assertions.” The third area is deduction, which is defined as “determining whether certain conclusions necessarily follow from 26 information in given statements or premises.” The fourth area is interpretation, which is defined as “weighing evidence and deciding if generalizations or conclusions based on the given data are warranted.” The last area is evaluation of arguments and is defined as “distinguishing between arguments that are strong and relevant and those that are weak or irrelevant to a particular question at issue” (Watson & Glaser, 1994, pp. 9-10). Each of the abovementioned subareas is measured in a respective subtest of the WGCTA: (a) Inference, (b) Recognition of Assumptions, (c) Deduction, (d) Interpretation, and (e) Evaluation of Arguments. In each of the subtests, the examinee reads brief passages or scenarios that reflect real-world problems, statements, arguments, and interpretations. The examinee then responds to several items for each passage or scenario. The scenarios can fall into two categories: neutral and controversial. For example, neutral scenarios entail subject matter that people do not generally have strong feelings or prejudices about (e.g., the weather). The controversial scenarios include content about politics and social issues that people often do have strong feelings about. The controversial-content scenarios are effective in tapping into the examinee’s ability to think and evaluate evidence that may challenge their beliefs (the second component of a skills approach mentioned above). Again, a skill in critical thinking is to override opinions, attitudes, and biases that may affect a correct response (Watson & Glaser, 1994; Sa, West, & Stanovich, 1999). The Cornell Critical Thinking Test (CCTT). The Cornell Critical Thinking Test (CCTT; Ennis, Millman, & Tomko, 1985) is also a widely used measure of critical thinking with acceptable reliability, internal consistency, and validity. The 27 CCTT features two separate tests, Level X and Level Y. Level X is designed for students in grades 4 through early college. Level Z targets advanced and gifted high school students, college students, and other adults. The CCTT is designed to be a “general critical thinking skills test” as it covers critical thinking as a whole. Both tests feature multiple-choice items, each with three choices and one correct answer. Level X has 71 items and Level Z has 52 items. An evaluation of the psychometric properties of the CCTT Level X and WGCTA Form YM based on the 10 essential validity standards and the 5 essential reliability and measurement error standards from the Standards for Educational and Psychological Tests (APA, 1985) indicated that the measures met the standards between the levels of "minimal" or "somewhat" (Modjeski & Michael, 1983). Ennis, Millman, and Tomko (1985) used the following working definition of critical thinking in the development of the CCTT: “Critical thinking is the process of reasonably deciding what to believe and do” (p.1). The authors note that there are numerous ways to subcategorize critical thinking including an approach that examines three types of inferences to beliefs (induction, deduction, and evaluation) and four types of bases for such inferences: the results of other inferences; observations; statements made by others; and assumptions. They further stress that close attention must be made to meaning in dealing with the three types of inferences and four types of bases. From this model of categorization, they conclude that a test of general critical thinking might cover induction, deduction, evaluation, observation, credibility (of statements made by others), assumption identification, and meaning. Lastly, they suggest that an ideal test of general critical thinking skills would include 28 “attitudes” of a critical thinker such as open-mindedness, caution, and valuing being well-informed, but they do not directly test for these components because of the difficulty in doing so. Thus, the aspects of critical thinking incorporated into the CCTT are induction, deduction, observation, credibility, assumptions, and meaning (Ennis, Millman, & Tomko, 1985). Operational definitions are not included for these aspects, but these can be gleaned from the literature from which they are derived. Using Halpern’s (1998) general critical thinking skills taxonomy, the WGCTA and CCTT provide items designed to measure specific skill areas. These two measures were reviewed for two reasons. First, they are the two most widely validated and utilized critical thinking assessment devices (Watson & Glaser, 1980; 1994; Ennis, Millman, & Tomko, 1985). Secondly, they have strong overlap in content area. In other words, both assessments are designed to measure extremely similar subareas of critical thinking that, when taken together, provide a composite of critical thinking. 1.13 Critical Thinking in the Health Care Professions If we paraphrase Ennis, Millman, & Tomko’s (1985) brief definition of critical thinking as the process of reasonably deciding what to believe or do, it is clear that this is an important function for all health care providers. Professionals are often faced with limited information and time constraints and forced to make decisions that are sometimes literally life or death. Because of this, critical thinking is recognized as an integral part of many healthcare professionals’ education and training. For example, the Council of Baccalaureate and Higher Degree Programs designate critical 29 thinking as a required outcome criterion for the National League for Nursing accreditation process (Adams, Whitlow, Stover, & Johnson, 1996). Critical thinking skills are frequently assessed as an outcome measure after courses designed to teach these skills in medical and nursing schools. There is a large body of literature on teaching and measuring critical thinking skills from the field of nursing. Much of this literature illustrates the role of critical thinking in nursing activities (e.g., Boychuck, 1999), teaching critical thinking to nursing students (e.g., Carter & Gentry, 2000) or the use of critical thinking measures to assess the learning of critical thinking skills in students (e.g., Frye, Alfred, & Campbell, 1999). Critical thinking is also a frequently discussed subject in physician training. Scott and Markert (1994) tested critical thinking skills in medical students using the Watson-Glaser Critical Thinking Appraisal and found that critical thinking skills correlated with student academic success in the first two years of medical school and with MCAT scores. They concluded that critical thinking skills are one factor involved in a student’s success in the first two years of medical school (Scott & Markert, 1994). 1.14 Critical Thinking Skills in Professional Psychology Very little research has examined critical thinking skills per se among psychologists or psychology students. Some have warned of the inherent danger of “common sense” to psychologists as a possible enemy of critical thinking (Fletcher, 1984). Some empirical research has found that German female psychologists rated significantly higher than a group of control professionals on criteria of “wisdom- 30 related knowledge” (Smith, Stuadinger, & Baltes, 1994). However, no research has been conducted examining critical thinking in professional psychologists. One study by Roe (1999) conducted with psychology students examined whether believers in the paranormal differed in terms of critical thinking as compared to non-believers. The author reports that no significant difference was found, but it should be noted that critical thinking was not measured using a standardized assessment but rather through subjects’ written evaluation of a paranormal study and their assignment of a Likert scale score of the overall quality of the study (Roe, 1999). 1.15 Heuristics and Biases Research on judgment under uncertainty, which has come to be known as the heuristics and biases approach (Kahneman, Slovic, & Tversky, 1982), has attempted to identify specific mental operations that affect intuitive predictions and judgments. Some research has examined the role of heuristics and biases in psychologists’ decision making. For example, Garb (1996) found that the representativeness heuristic was descriptive of clinicians’ cognitive processes when making clinical diagnoses. The representativeness heuristic involves judging something by intuitively comparing it to a prototype or a mental representation of a category (Myers, 1996). Garb concluded that when the representativeness heuristic was a factor in the decision making process that it can be inferred that the clinician was not attending to base rates (Garb, 1996). In fact, individuals’ tendency to use or misuse base-rate information is commonly found in the literature on cognitive heuristics and biases (Stanovich & West, 1998). 31 Base-rate information refers to the rate or occurrence of a phenomenon within a given population. There are two forms by which base-rate use is described in the literature: base-rate neglect and base-rate fallacy. Base-rate neglect refers to situations in which an individual does not use base-rate information when making a decision, but does not imply whether the base-rate information should have been used. On the other hand, base-rate fallacy implies that base-rate information was ignored when it should have been used in the decision-making process (Gigerenzer, Hell, & Blank, 1988). Other definitions describe base-rate neglect as attending more to the hit rate (the representativeness) than the base-rate (Fiedler, Brinkmann, Betsch, & Wild, 2000). For example, one might accord an anecdote (a co-worker’s negative experience with a car) and base-rate data (outstanding review and large survey in Consumer Reports) equal weight. In this example the base-rate information that a large sample of people are pleased with the product is underused when it is given equal weight to a single anecdote. When we ignore or underuse relevant base-rate information, we are more likely to make errors in judgment. No previous research has examined psychologists’ actual skill level in making decisions. One potential factor in theoretical orientation/choice of therapeutic interventions is clinicians’ critical thinking skills. This is the first study to examine theoretical orientation by using a proxy system in which clinicians endorse actual treatment approaches and techniques that they use. Although some have called for “instruction in critical thinking in graduate-level classrooms” to help “stem the rising tide of pseudoscientific treatments” (Kalal, 1999, p. 83), this is the first study to examine critical thinking skills in psychologists. 32 The purposes of this study were as follows: 1) To examine the relative frequency of use of various psychotherapeutic approaches associated with the major theoretical orientations in professional psychology; 2) To obtain descriptive information on the critical thinking skills of practicing psychologists; 3) To obtain data on professional psychologists’ utilization of Power/Energy Therapy techniques; 4) To examine the relationship between psychologists’ self-described theoretical orientation and their self-reported practical orientation or use of specific techniques and approaches derived from the major theoretical orientations and; 5) To examine whether a relationship exists between psychologists’ critical thinking skills and practical/theoretical orientation, as well as their use of Power/Energy techniques. Professional psychologists were surveyed regarding their practical/theoretical orientation. Further, they completed an assessment of critical thinking skills designed specifically for this study. It was hypothesized that critical thinking skills would influence psychologists’ decisions about what treatment approaches to provide to their clients. Thus, psychologists with relatively weak critical thinking skills would be more prone to adopt treatment approaches that tend not to be developed within a scientific framework, and that are based on scientifically questionable theories. In particular, it is hypothesized that psychologists that utilize Power/Energy Therapy techniques will have lower scores on the assessment of critical thinking when compared to those that do not use these techniques. 33 2. METHOD 2.1 Participants Participation was solicited from the following APA divisions: 21 Fellows and 146 Members of Division 12 (Clinical Psychology), 17 Fellows and 150 Members of Division 29 (Psychotherapy), and 3 Fellows and 164 Members of Division 42(Psychologists in Independent Practice). Participants were chosen from the APA Membership Directory through the use of a systematic sampling technique. Selection began at the member number matching a number selected from a random numbers table. From this starting point, subjects were chosen based on total number of members in the division divided by 100. For example, every 30th member of Division 12 was selected and every 13th member of Division 17 was selected. 80 packets were also mailed to members of the Association for Comprehensive Energy Psychology (ACEP). ACEP members were selected from the member directory available on its Internet web site (www.energypsych.org, 2003). In an effort to send packets to ACEP members that are practicing psychologists, those that listed credentials other than a master’s degree (i.e., M.A., M.S., or M.Ed) or doctorate (i.e., Ph.D., Psy.D., or Ed.D) were excluded. Thus, individuals reporting M.S.W., M.D., or other nonpsychology degrees, those that reported a bachelors as the highest degree, and those that did not list their highest degree were all excluded. The groups (ACEP and APA divisions) were selected in an attempt to obtain a diverse sample with respect to practice orientation. 34 2.2 Procedure Participants were sent via post a research questionnaire packet and asked to complete the enclosed demographic form and questionnaires and return them in the provided self-addressed-stamped envelope. The entire questionnaire packet required no more than 25-30 minutes to complete. Total survey response rates based on previous studies of randomly selected samples of clinical and counseling psychologists have varied considerably. Zook and Walton (1989) received an unusually high response rate of 66.5% in their study of theoretical orientation and work setting. They sent the survey followed by a reminder postcard 30 days later to non-responders. Thirty days after the postcard was sent they mailed another survey to those who still had not responded. Finally, 30 days later a third survey was sent to those who had still not responded. Haas, Maylouf, and Mayerson (1988) received 59% of surveys back of those mailed to members of APA’s Division of Psychotherapy. Their study involved responding to 10 ethical dilemma vignettes. Allison, Echemendia, Crawford, & Robinson (1996) achieved a return rate of 49% from a single mailing in their study of psychologists’ training and work experience with clients from diverse groups. Johnson & Brems (1991) likewise achieved a 49% response rate based on an initial and a follow-up mailing in their study of psychologists’ theoretical orientation. Polusny & Follette (1996) surveyed psychologists’ attitudes and beliefs about Child Sexual Abuse (CSA) that included questions about the participant’s own history of sexual abuse. Despite their low 22% response rate, they were able to demonstrate that the sample was representative of the APA membership population by comparing reported demographic information to a 35 directory survey compiled by the Office of Demographic, Employment, and Educational Research (APA, 1993). Thus, the response rate for the present study was anticipated to range from 22%-66.5%. However, safeguards employed in previous studies (e.g., reminder postcards) were not used because of anonymity requirements imposed by the Drexel University Institutional Review Board (IRB). Further, no incentives were offered because of these strict confidentiality requirements. 2.3 Instrumentation Each participant was mailed a research protocol packet consisting of a cover letter, demographics sheet, Critical Thinking Questionnaire (CTQ), Treatment Approaches and Techniques Questionnaire (TATQ), and a self-addressed-stamped envelope. Cover letter. The cover letter provided a brief description of the study and directions to complete the enclosed demographic sheet and questionnaires and return them in the self-addressed-stamped envelope within four weeks. Demographics Form. This form was used to request the following information: age, gender, years since graduation, years of therapy experience, weekly hours spent in therapy provision, highest degree, work setting, and theoretical orientation. The following were forced choice items: gender (male, female), degree (M.A./M.S./M.S.W., Ph.D., Ed.D., Psy.D., or other please specify), work setting (academic, agency, or independent practice), and theoretical orientation (Systems/Family Systems, Cognitive-Behavioral, Psychoanalytic/Dynamic, Power/Energy, Existential/Humanistic/Phenomenological, Radical 36 Behavioral/Applied Behavior Analytic, and Eclectic). The work setting items were derived from Zook and Walton (1989). See Appendix A for demographics form. Critical Thinking Questionnaire (CTQ). The Critical Thinking Questionnaire is a theoretically derived measure that was created for the purposes of this study (Appendix B). The questionnaire consists of items based on several established measures of critical thinking and several published studies of critical thinking. The sources of the items are identified in Appendix B. The CTQ was created so that all of the test items would be pertinent to the practice of psychology. The CTQ is intended to tap into critical thinking in general, but also as it applies to practicing psychologists. Therefore, the CTQ was created by adapting various, existing critical thinking measure items to our specific population. Further, the CTQ requires less time to complete than existing critical thinking measures. Because the construct of “critical thinking” is a composite of a number of specific skills and abilities, this assessment was developed to measure five specific sub-areas of critical thinking. These five areas were derived from the Watson-Glaser Critical Thinking Appraisal and the following descriptions are from the WGCTA Manual. The critical thinking skills categories are used for the development of a composite to test the construct of critical thinking. The first area is inference, which is defined as “discriminating among degrees of truth or falsity of inferences drawn from given data.” The second area is recognition of assumptions, which is defined as “recognizing unstated assumptions or presuppositions in given statements or assertions.” The third area is deduction, which is defined as “determining whether certain conclusions necessarily follow from 37 information in given statements or premises.” The fourth area is interpretation, which is defined as “weighing evidence and deciding if generalizations or conclusions based on the given data are warranted.” The last area is evaluation of argument and is defined as “distinguishing between arguments that are strong and relevant and those that are weak or irrelevant to a particular question at issue” (Watson & Glaser, 1994, pp. 9-10). The CTQ is made up of items from the WGCTA, the CCTT, and Stanovich (2001) to provide a broad range of questions adaptable to psychologyrelated areas. The CTQ is a 28-item multiple-choice format measure. The participant is provided with a range of two to six possible answers depending on the question. Each item has only one correct answer. See Appendix B for the CTQ and Appendix C for an index of item-by-item sources. Treatment Approaches and Techniques Questionnaire (TATQ). Various scales exist that assess clinicians’ theoretical orientation that tap into epistemic variables (e.g., Theoretical Orientation Survey; TOS, Coan, 1979). This study focused less on epistemology of practice in favor of topography of practice. In other words, the goal was to know what clinicians’ actually do rather than what they think they are doing. The Treatment Approaches and Techniques Questionnaire (TATQ) was also created for the purposes of this study (Appendix D). The measure consists of a list of 36 treatment approaches/techniques. The approaches/techniques are each associated with one of six theoretical orientations with respect to psychotherapy. There are six approaches/techniques from each of the following theoretical orientations: systems/family systems, cognitive-behavioral, psychoanalytic/psychodynamic, 38 power/energy, existential/humanistic/phenomenological, and radical behavioral/applied behavior analysis. The participant rates each item on a Likert scale indicating their current or potential use of the approaches/techniques (0-never use/would not use, 1-sometimes use/would possibly use, 2-frequently use/would probably use, and 3-almost always use/would definitely use). The item order was randomly assigned. See Appendix D for TATQ and Appendix E for match of items and theoretical orientation. 2.4 Principal Hypotheses 1) Higher composite scores on a measure of Power/Energy Therapy utilization will be related to significantly lower scores on the Critical Thinking Questionnaire. 2) Higher composite scores on a measure of Cognitive-Behavioral Therapy utilization will be related to significantly higher scores on the Critical Thinking Questionnaire. 39 3. RESULTS As noted above, 501 data packets were mailed to the following APA divisions: 21 Fellows and 146 Members of Division 12 Clinical Psychology, 17 Fellows and 150 Members of Division 29 Psychotherapy, and 3 Fellows and 164 Members of Division 42-Psychologists in Independent Practice. 80 packets were also mailed to members of the Association for Comprehensive Energy Psychology (ACEP). Sixty-eight packets were returned as undeliverable. Six packets were returned not completed due to either the recipient not being interested in participating or notification that the recipient was deceased. Of the remaining 513 packets, 79 were returned: 63 from APA division sample and 16 from ACEP sample. This is an approximately 15% response rate and is lower than anticipated. An a priori power analysis was conducted to determine an appropriate sample size for the multiple regression analysis testing the principal study hypotheses. Given an α level of .05, medium effect size of r = .30, and the convention for power of .80, a total sample size of 53 was viewed as appropriate for the main analysis. Post hoc power analyses were conducted for the main statistical analysis. Using the conventions of .05 for alpha level and a medium effect size of .30, the total sample size of 79 provided power of .96 for the multiple regression analysis. This clearly exceeds the convention for power of .80. Therefore, there was sufficient power for the main analysis. 40 3.1 Demographics Demographic data are presented in Table 1. The third column of Table 1. shows results from a 2000 survey of the APA membership (APA, 2000). It should be noted that the APA survey included all members of the association and therefore was comprised of psychologists outside of the practice domain (e.g., experimental psychologists) as well. Overall, the present sample is quite comparable to the larger membership of APA with respect to age, gender, ethnicity, and degree. Compared to the APA data, the current sample included a slightly higher percentage of male psychologists. The mean age of the APA sample was 52.2 years with a standard deviation of 12.4 years (APA, 2000). The modal age range for the current sample was 50-59 years. Due to limitations imposed by the Drexel University IRB, participants of the current study were not asked to report their actual age. Thus, it is difficult to compare the current sample to the APA survey data. However, it appears that the current sample may have been, on average, slightly older than the APA membership. In addition, as would be expected from a sample of practitioners, a somewhat higher percentage of the current sample participants endorsed a Psy.D. rather than a Ph.D. as the highest degree obtained. Personal Characteristics. As shown in Table 1, 48 (60.8%) of the respondents were men, 29 (36.7%) were women, and 2 (2.5%) declined to answer this question. The median age range of respondents was 50-59 years. 82% of respondents (n=65) described themselves as white or Caucasian, 1 person described him/herself as African-American, 1 person described him/herself as Native American, and 12 respondents (15%) declined to answer this question. 41 Table 1. Demographics of Study Sample and 2000 APA Membership Survey Data Sample n Sample % APA Survey % Gender Male Female Did not answer 48 29 2 60.8 36.7 2.6 51.4 48.6 0.0 20-29 30-39 40-49 50-59 60-69 70-79 80+ Did not answer 0 4 10 30 24 7 2 2 0 5.1 12.7 38.0 30.4 8.9 2.5 2.5 0.6 (under 30yrs) 13.5 24.6 31.2 10.7 9.4 (70yrs+) Age 10.0 Racial/Ethnic Group White Black Native American/ Indian Asian Hispanic Did not answer/other 65 1 82.3 1.3 76.8 1.7 1 0 0 12 1.3 0.0 0.0 15.2 0.3 1.7 2.1 17.3 Ph.D. Psy.D. M.A./M.S./M.Ed. Ed.D. Did not answer 56 10 6 5 2 70.9 12.7 7.6 6.3 2.5 75.6 7.3 6.5 4.5 6.2 (did not answer/other) 54 15 7 3 68.4 19.0 8.9 3.8 * * * * Degree Work Setting Indep. Practice Agency Academic Did not answer Model of Graduate Program ScientistPractitioner 26 32.9 NA ProfessionalScientist 25 31.6 NA Professional 24 30.4 NA Did not answer 4 5.1 NA ______________________________________________________________________________ Note: n = 79. * present study used different categories for work setting than the APA survey. NA=not asked in APA survey. APA data from 2000 APA Directory Survey (APA, 2000). 42 Professional Characteristics. Fifty-six (70.9%) of the respondents reported a Ph.D. as their highest obtained degree, 10 (12.7%) reported a Psy.D. as highest obtained degree, 5 (6.3%) reported an Ed.D. as highest obtained degree, 6 (7.6%) reported an M.A., M.S., or MEd. as the highest obtained degree, and 2 (2.5%) declined to answer. The range of years since graduation was from 2-53 years with a mean of 23 years, and median and mode of 25 years. The range of years of experience as a clinician or therapist was from 3-54 years with a mean of 26 years, median of 25.5 years, and mode of 20 years. The range of average hours per week spent providing therapy or counseling was from 0-50 hours with a mean of 23.5 hours, median of 22.5 hours and mode of 20 hours per week. 54 (68.4%) of the respondents reported independent practice as their primary work setting, 15 (19%) reported an agency as their primary work setting, 7 (8.9%) reported an academic work setting as primary, and 3 (3.8%) respondents declined to answer. Twenty-four respondents (30.4%) identified Professional (practitionerscholar) as the model of their graduate program, 25 (31.6%) identified ProfessionalScientist (practitioner-scientist) as the model of their graduate program, 26 (32.9%) identified a Scientist-practitioner (Boulder model) graduate program, and 4 (5.1%) respondents declined to answer. As expected, participants listed an extensive variety of Certifications/additional training. A total of 29 participants (36.8%) did not provide a response to this part of the demographic form. The most common responses were completion of a Post-doc (n=7); ABPP (n=7); training in EMDR Level I (n=6) or Level II (n=7); training in TFT Level I (n=3), Level II (n=1), or TFTdx (n=2), and EFT (n=4). 43 Theoretical Orientation. Respondents were asked to rank order the list of theoretical orientations. Table 2 shows the number and percentage of responses of each rank by theoretical orientation. Cognitive-behavioral and Eclectic orientations were the two most ranked number one with 23 each (29.1%). The Psychoanalytic/dynamic orientation was a close second with 20 responses (25.3%). 8 respondents (10.1%) ranked the Existential/Humanistic/Phenomenological orientation number one. 3 (3.8%) of respondents ranked the Systems/Family Systems orientation number one. Both the Radical Behavioral/ABA and Power/Energy orientations were each ranked number one by only 2 respondents (2.5%). Orientations not ranked were scored as zeros. If a respondent did not rank or differentiate the theoretical orientations, but did endorse one or more (e.g., checkmarks, multiple orientations ranked as 1) the endorsed items were each scored as a 1. 3.2 Critical Thinking Questionnaire (CTQ) Seventy-eight Critical Thinking Questionnaires (CTQ’s) were completed. Total score was calculated by summing the number of correct answers. Thus, total scores could range from zero to 28. Unanswered questions were scored as incorrect. Table 3. shows frequency and overall percentage of correct responses for each of the items on the CTQ. CTQ Total Score. The 63 member APA sample had a mean CTQ total score of 21.70 (SD=3.43) and the 15 ACEP member sample had a mean CTQ total score of 20.13 (SD=4.17). There was not a statistically significant difference between groups when comparing CTQ total scores between sample membership, t (77) = 1.581, p=.118. There was also not a statistically significant difference between groups when 44 Table 2. Rank Orders of Theoretical Orientation N (%) Cognitive-Behavioral 1 2 3 4 5 6 0 Eclectic 1 2 3 4 5 0 Psychoanalytic/Dynamic 1 2 3 4 5 6 0 Existential/Humanistic/ Phenomenological 1 2 3 4 5 0 Systems/ Family Systems 1 2 3 4 5 6 0 Power/Energy 1 2 3 4 6 7 0 Radical Behavioral/ABA 1 2 3 5 6 7 0 23 (29.1%) 22 (27.8%) 11 (13.9%) 6 (7.6%) 2 (2.5%) 1 (1.3%) 14 (17.7%) 23 (29.1%) 9 (11.4%) 9 (11.4%) 8 (10.1%) 5 (6.3%) 25 (31.6%) 20 (25.3%) 8 (10.1%) 10 (12.7%) 5 (6.3%) 4 (5.1%) 1 (1.3%) 31 (39.2%) 8 (10.1%) 8 (10.1%) 12 (15.2%) 9 (11.4%) 2 (2.5%) 40 (50.6%) 3 (3.8%) 12 (15.2%) 7 (8.9%) 8 (10.1%) 6 (7.6%) 2 (2.5%) 41 (51.9%) 2 (2.5%) 9 (11.4%) 1 (1.3%) 1 (1.3%) 2 (2.5%) 2 (2.5%) 62 (78.5%) 2 (2.5%) 1 (1.3%) 4 (5.1%) 4 (5.1%) 3 (3.8%) 3 (3.8%) 62 (78.5%) Note: n = 79, rankings with zero responses were excluded. 45 Table 3. CTQ Items Item # and Type 1. Inference (Base rate) 2. Interpretation 3. Interpretation 4. Interpretation 5. Interpretation 6. Interpretation 7. Interpretation 8. Interpretation 9. Deduction 10. Deduction 11. Deduction 12. Deduction 13. Recog. of Assumptions 14. Recog. of Assumptions 15. Recog. of Assumptions 16. Recog. of Assumptions 17. Recog. of Assumptions 18. Recog. of Assumptions 19. Recog. of Assumptions 20. Evaluation of Arguments 21. Evaluation of Arguments 22. Evaluation of Arguments 23. Evaluation of Arguments 24. Evaluation of Arguments 25. Evaluation of Arguments 26. Evaluation of Arguments 27. Inference 28. Inference Note: n=78. Number of Correct Responses (%) 17 (21.8%) 61 (79.2%) 63 (80.8%) 73 (93.6%) 72 (92.3%) 58 (74.4%) 63 (80.8%) 68 (87.1%) 74 (94.9%) 65 (83.3%) 67 (85.9%) 74 (94.9%) 65 (83.3%) 75 (96.2%) 66 (84.6%) 64 (82.1%) 60 (76.9%) 36 (46.2%) 30 (38.5%) 72 (92.3%) 60 (76.9%) 75 (96.2%) 41 (52.6%) 66 (84.6%) 44 (56.4%) 62 (79.4%) 47 (60.3%) 51 (65.3%) 46 comparing CTQ total scores by gender, t (75) = .358, p = .765. A one-way analysis of variance (ANOVA) did not reveal any statistically significant differences when comparing CTQ scores by highest obtained degree, F(3,73)=1.678, p=.179. A second one-way ANOVA revealed a marginally statistically significant difference when comparing CTQ scores by work setting, F(3,73)=2.406, p=.097. Tukey HSD post-hoc comparisons showed the largest mean difference to be 2.16 points between the Independent Practice (n=54; M=20.78) and Agency (n=15; M=22.93) work settings, p=.104. Thus, respondents that endorsed an agency as their main work setting tended to have higher CTQ total scores than those reporting independent practice as their main work setting. There were no significant effects for the small number of participants endorsing an academic work setting (n=7; M=22.29). A third one-way ANOVA also revealed a marginally statistically significant difference when comparing CTQ scores by model of graduate program, F(3,72)=2.595, p=.082. Tukey HSD post-hoc comparisons showed a mean difference of 2.29 points between the Professional school model (M=20.21) and Boulder model (M=22.50) that was approaching statistical significance, p=.066. Thus, graduates of Boulder model programs tended to have higher total scores on the CTQ when compared to graduates of Professional school programs. A fourth one-way ANOVA did not find any statistically significant differences when comparing CTQ scores by first rank-ordered orientation, F(5,69)=.300, p=.911. In other words, when participants were grouped based on the theoretical orientation they ranked as most descriptive, there were no significant differences in critical thinking scores. 47 A simultaneous multiple regression was conducted using age, average number of hours per week providing therapy or counseling, years of experience as a therapist/clinician, and years since graduation from highest degree as the predictor variables and CTQ total score as the dependent variable. The results indicate that the regression was a poor fit (R2adj = .094) but the overall relationship was significant (F4, 71= 2.955, p<. 026). With other variables held constant, number of years of experience was the only statistically significant predictor (β=-.463, p<.047). Thus, when partialling out the variance of age, years since graduation, and number of hours per week treating clients, an increase in years of experience as a clinician was associated with a decrease in total scores on the CTQ. CTQ Subscales. Inference, Interpretation, Deduction, Recognition of Assumptions, and Evaluation of Assumption subscale scores were calculated by adding the number of correct responses from each category. Table 4. shows the number of items, range, mean, standard deviation, and mean percentage of correct responses for each of the CTQ subscales. Five independent-samples t-tests were conducted to examine whether group differences existed on any of the subscales when comparing the APA sample to the ACEP sample. T-tests were conducted using sample membership as the independent variable (APA vs. ACEP) and each of the five CTQ subscales (total number of correct items from each subscale) as the dependent variables. Two t-tests showed significant effects by group. On the Interpretation and Deduction subscales, the APA sample had significantly higher scores on both, t (76)=2.410, p<.018 and t (76)=2.037, p<.045, respectively. On the Interpretation subscale, the means for APA 48 Table 4. CTQ Subscale Scores and Means # of Items APA Sample Mean (# correct) SD Observed Range Mean % Correct ACEP Sample Mean (# correct) SD Observed Range Mean % Correct Total Sample Mean (# correct) SD Observed Range Mean % Correct Note: n=78 Inference Subscale 3 Interpretation Subscale 7 Deduction Subscale 4 Recognition of Evaluation of Assumptions Arguments Subscale Subscale 7 7 1.53 .97 6.05 1.22 3.68 .62 5.10 1.28 5.37 1.12 0-3 51% 2-7 86% 2-4 92% 1-7 73% 3-7 77% 1.19 .98 5.19 1.47 3.25 1.13 5.00 1.37 5.44 1.63 0-3 40% 2-7 74% 0-4 81% 2-7 71% 0-7 77% 1.46 .98 5.87 1.31 3.59 .76 5.08 1.29 5.38 1.23 0-3 49% 2-7 84% 0-4 90% 1-7 73% 0-7 77% 49 (M= 6.05) and ACEP (M=5.19) provided a mean difference effect size of .86. On the Deduction subscale, the means for APA (M= 3.68) and ACEP (M=3.25) provided a mean difference effect size of .43. Thus, while there were no mean differences on CTQ total score by group membership, on the Interpretation and Deduction subscales of the CTQ, APA members had significantly higher scores than ACEP members. 3.3 Treatment Approaches and Techniques Questionnaire (TATQ) Seventy-eight TATQ’s were completed. Items that were left blank were scored as a zero. Table 5. shows frequency of responses for each item on the TATQ. Data Summarization. A principal components factor analysis with Varimax rotation was conducted to examine the factor structure of the TATQ. Three components were extracted and factor loadings of .6 or greater were considered significant (Hair, Anderson, Tatham, & Black, 1995). The first factor is primarily comprised of Cognitive-Behavioral, Radical Behavioral/ABA, and Systems/Family Systems techniques. The second factor features five of the six Psychoanalytic/Dynamic techniques (the free association item had a factor loading of .589 and was thus excluded) and non-directive support and promotion of selfactualization, which were a priori considered techniques from the E/H/P orientation. The third factor was made up of the six P/E techniques. In addition to free association, four other techniques had nonsignificant loadings: mirroring, unconditional positive regard, logotherapy, and re-authoring (see Table 6. for item loadings). Composite Scores. Composite TATQ scores were created by adding the participants’ responses from each of the theoretical orientation categories. Therefore, 50 Table 5. TATQ Item Frequencies Frequency counts (%) 0 1 2 3___ 63 (80.8) 55 (70.5) 64 (82.1) 61 (78.2) 59 (75.6) 59 (75.6) 2 (2.6) 8 (10..3) 1 (1.3) 9 (11..5) 5 (6.4) 8 (10..3) 5 (6.4) 11 (14.4) 5 (6.4) 4 (5.1) 7 (9.0) 5 (6.4) 8 (10.3) 4 (5.1) 8 (10.3) 4 (5.1) 7 (9.0) 6 (7.7) 6 (7.7) 5 (6.4) 27 (34.6) 37 (47.4) 10 (12.8) 59 (75.6) 14 (17.9) 19 (24.4) 26 (33.3) 26 (33.3) 16 (20.5) 11 (14.1) 19 (24.4) 29 (37.2) 18 (23.1) 9 (11.5) 32 (41.0) 6 (7.7) 39 (50.0) 25 (32.1) 7 (9.0) 6 (7.7) 20 (25.6) 2 (2.6) 29 (37.2) 16 (20.5) 8 (10..3) 13 (16.7) 44 (56.4) 14 (17.9) 31 (39.7) 41 (52.6) 39 (50.0) 34 (43.6) 11 (14.1) 14 (17.9) 12 (15.4) 17 (21.8) 24 (30.8) 25 (32.1) 18 (23.1) 25 (32.1) 6 (7.6) 4 (5.1) 7 (9.0) 6 (7.7) 5 (6.4) 25 (32.1) 3 (3.8) 3 (3.8) 32 (41.0) 11 (14.1) 4 (5.1) 31 (39.7) 12 (15.4) 27 (34.6) 23 (29.5) 20 (25.6) 25 (32.1) 26 (33.3) 37 (47.4) 34 (43.6) 17 (21.8) 24 (30.8) 36 (46.2) 12 (15.4) 26 (33.3) 14 (17.9) 6 (7.7) 23 (29.5) 13 (16.7) 9 (11.5) 47 (60.3) 51 (65.4) 23 (29.5) 29 (37.2) 35 (44.9) 67 (85.9) 21 (26.9) 22 (28.2) 30 (38.5) 30 (38.5) 30 (38.5) 9 (11.5) 7 (9.0) 4 (5.1) 21 (26.9) 14 (17.9) 7 (9.0) 2 (2.6) 3 (3.8) 1 (1.3) 4 (5.1) 5 (6.4) 6 (7.7) 0 (0.0) 36 (46.2) 52 (66.7) 51 (65.4) 30 (38.5) 36 (46.2) 65 (83.3) 30 (38.5) 20 (25.6) 15 (19.2) 31 (39.7) 23 (29.5) 7 (9.0) 8 (10..3) 6 (7.7) 9 (11.5) 14 (17.9) 16 (20.5) 4 (5.1) 4 (5.1) 0 (0.0) 3 (3.8) 3 (3.8) 3 (3.8) 2 (2.6) Power Energy tapping of acupressure/acupuncture points bilateral stimulation (e.g., eye movements) stimulation of energy meridians muscle-testing/applied kinesiology body-energy work touch and breath E/H/P unconditional positive regard non-directive support mirroring experiments in directed awareness promotion of self-actualization logotherapy Psychoanalytic/Dynamic free association dream analysis analysis/interpretation of resistances analysis/interpretation of transference maintenance of analytic framework ego strengthening Cognitive-Behavioral cognitive restructuring social skills training breathing retraining homework/behavioral experiments relaxation methods exposure exercises Radical Behavioral/ABA token economy avoidance of loss contingency required relaxation self-modeling shaping time delay prompting Systems/Family Systems genogram work family sculpting family reconstruction family mapping enactments re-authoring Note: n=78; 0 = Never use/Would not use, 1 = Sometimes use/Would possibly use, 2 = Frequently use/Would probably use, 3 = Almost always use/Would definitely use. 51 Table 6. Rotated Component Matrix with Item Loadings Components TATQ Items C/B, ABA, Sytms 1. muscle-testing/applied kinesiology .434 2. shaping .758* 3. analysis/interpretation of transference .348 4. family mapping .612* 5. time delay prompting .711* 6. enactments .635* 7. touch and breath .396 8. free association .171 9. bilateral stimulation (e.g., eye movements) .479 10. avoidance of loss contingency .767* 11. cognitive restructuring .805* 12. required relaxation .689* 13. genogram work .659* 14. homework/behavioral experiments .809* 15. body-energy work .362 16. mirroring .519 17. exposure exercises .777* 18. unconditional positive regard .504 19. non-directive support .419 20. experiments in directed awareness .614* 21. family reconstruction .667* 22. self-modeling .726* 23. tapping of acupressure/acupuncture points .361 24. stimulation of energy meridians .338 25. breathing retraining .615* 26. relaxation methods .791* 27. maintenance of analytic framework .263 28. promotion of self-actualization .380 29. social skills training .706* 30. family sculpting .655* 31. dream analysis .389 32. analysis/interpretation of resistances .415 33. ego strengthening .269 34. token economy .789* 35. logotherapy .592 36. re-authoring .569 Note: * indicates significant loading (i.e., Eigenvalue greater than .60) Dynamic .383 .285 .841* .431 .483 .444 .400 .589 .303 .333 .248 .363 .438 .179 .311 .385 .222 .491 .696* .394 .450 .387 .264 .285 .322 .258 .854* .619* .410 .508 .763* .797* .806* .315 .350 .549 P/E .770* .271 .218 .392 .365 .331 .734* .333 .657* .301 .343 .377 .322 .351 .849* .523 .259 .468 .306 .402 .317 .245 .853* .862* .509 .427 .175 .498 .377 .368 .318 .231 .323 .205 .497 .339 52 each participant had a score between 0 and 18 for each of the theoretical orientations. A score of zero would indicate that they answered 0 or Never use/Would not use for all six of the therapeutic techniques from that theoretical orientation category. A score of 18 would indicate that they endorsed a 3 or Almost always use/Would definitely use for all six of the therapeutic techniques from that theoretical orientation category. Means of composite scores can be used as an indicator of the popularity of techniques from each of the theoretical orientations. When comparing mean composite scores by sample type, there was only one significant difference: P/E score. The mean P/E score of the APA sample was 1.03 with a standard deviation of 2.80. The mean P/E score of the ACEP was 9.56 with a standard deviation of 5.48. A t-test revealed that this difference was significant, t (77) = -8.741, p< .0001, ES=.84. Thus, not surprisingly, members of an organization devoted to “comprehensive energy psychology” had significantly higher scores on the P/E composite than did APA members. A one-way analysis of variance (ANOVA) did not reveal any statistically significant differences when comparing P/E scores by participants’ endorsed model program, F(2,72)=1.464, p=.238. A second one-way ANOVA did not reveal any statistically significant differences when comparing P/E scores by highest obtained degree, F(3,73)=.917, p=.437. Thus, there were no statistically significant differences on the Power/Energy composite scores when grouping participants by their degree or model graduate program. 53 3.4 Multiple Regression Analyses Composites. A simultaneous multiple regression was completed using the six composite TATQ scores from each of the theoretical orientations as the predictor variables and CTQ total score as the dependent variable. The results indicate that the regression was a poor fit (R2adj = .114) but the overall relationship was significant (F6, 72= 2.665, p<. 022). Two of the regression weights were significant and therefore contributed to the multiple regression model: P/E score (β= -.341, p<. 008) and C/B score (β= .371, p< .021). Thus, increases in Power/Energy scores predicted decreases in Critical Thinking scores and increases in Cognitive-Behavioral scores predicted increases in Critical Thinking scores. A simple correlation between P/E scores and C/B scores was significant (r= .323, p< .004). A simple correlation between P/E scores and CTQ total was negative and significant (r= -.240 p< .033). A simple correlation between C/B scores and CTQ total was not significant (r= .170, p= .134). However, because C/B scores and P/E scores are significantly correlated, a partial correlation was done with C/B scores and CTQ total partialling out the variance of P/E scores. This correlation was positive and significant (r= .2694, p< .017). Further, a partial correlation between P/E scores and CTQ total partialling out the variance of C/B scores was negative and significant (r= -.3164 p< .005). The relation between age and years since graduation and several of the composite scores was examined using simple correlation analyses. Cognitivebehavioral composite scores were significantly negatively correlated with age (r=.312, p<.005) and years since graduation (r=-.285, p<.011). Dynamic scores were 54 significantly positively correlated with age (r=.260, p<.020) and years since graduation (r=.245, p<.029). Power/Energy scores were negatively correlated with age, although it was not statistically significant (r=.129, p<.257). However, P/E scores were significantly negatively correlated with years since graduation (r=-.286, p<.011). Also, further examination of the most frequently endorsed P/E technique, bilateral stimulation, revealed a significant negative correlation with age (r=-.222, p<.049) and years since graduation (r=-.331, p<.003). Therefore, an increase in age and number of years since graduation coincided with an increase in Dynamic scores. An increase in age and years since graduation coincided with a decrease in C/B and P/E scores and rating of bilateral stimulation item on the TATQ. Factors. A simultaneous multiple regression was conducted using the three factors derived from the factor analysis as the predictor variables and the CTQ total score as the dependent variable. The results indicate that the regression was a poor fit (R2adj = .076) and the overall relationship was not significant (F6, 72= 2.058, p=. 113). Therefore, several of the TATQ composite scores (P/E and C/B) were better predictors of CTQ total score than were the components derived from the factor analysis. 55 4. DISCUSSION The 15% response rate was lower than anticipated. One explanation is that the questionnaires were time consuming and challenging; particularly the CTQ, and most recipients chose not to or were unable to complete them. Despite the low response rate, the sample size was deemed adequate to complete the proposed data analyses. Based on comparing the sample demographic characteristics with the APA membership survey data, the sample is judged to be appropriately representative of practicing psychologists. Further, because of the low response rate, the results must be interpreted with caution. This study represents the first attempt to examine the role of critical thinking in practitioners’ choice of therapeutic techniques. It is also one of the first studies to go beyond the limited label of theoretical orientation and measure actual use of therapy techniques. Because of the popularity of a number of varied techniques, we can no longer infer from one’s stated theoretical orientation what is occurring behind the office door, and this study bears that out. With the partial exception of psychoanalytically and dynamically oriented psychologists, most practitioners reported that they do or would utilize a number of therapeutic techniques outside of their predominant orientation. Therefore, it can be concluded that with the exception of a segment of analytically and dynamically oriented practitioners, most psychologists appear to be eclectic in terms of their use of techniques. It is unclear from the present data whether these practitioners are most appropriately conceptualized as technically eclectic or unsystematically eclectic/theoretical integrationist. It is likely that unsystematically eclectic would be 56 the most fitting description because the range of techniques utilized would be difficult to reconcile under a single theoretical rubric, whether it be the theoretical orientations described in this study or the category of empirically supported treatments. Future research is needed to assess the role of empirical support for an intervention in psychologists’ decision-making process. 4.1 Hypotheses As hypothesized, participants who reported using a number of techniques from Power and Energy therapies scored significantly lower on the measure of critical thinking skills. Also as hypothesized, individuals who reported using a number of Cognitive-Behavioral techniques scored significantly higher on the measure of critical thinking skills. Thus, ability to think critically about therapeutic techniques may impact psychologists’ choices. Relatively strong critical thinking skills likely enable individuals to better evaluate information. For example, participants who responded to the survey from the Association for Comprehensive Energy Psychology reported significantly higher utilization of P/E therapies compared to the APA members. When compared to the APA sample, ACEP members had significantly lower scores on the Interpretation and Deduction subscales of the CTQ. If we revisit the definitions for the constructs of interpretation, “weighing evidence and deciding if generalizations or conclusions based on the given data are warranted” and deduction, “determining whether certain conclusions necessarily flow from information in given statements or premises,” it becomes clear how strengths or deficits in these areas could impact use of novel treatments. Individuals skilled in the 57 areas of interpretation and deduction may determine that proposed evidence for the efficacy of a novel treatment is not compelling. It is unclear what accounts for the negative correlation between years of experience and CTQ total. It is possible that this is an artifact of the relation between age and the dynamic orientation. In other words, it is possible that individuals trained in dynamic and analytic models experienced less emphasis on critical thinking skills as compared to more recently trained individuals who are more likely to be trained in the cognitive-behavioral model. It should be noted that several of the cognitive behavioral techniques appeared to be popular across participants. For example, only three respondents reported that they never use or would not use cognitive restructuring. Inversely, most of the Power/Energy techniques were not popular across all participants. For example, approximately 81% of participants reported that they do not or would not use the technique tapping of acupressure/acupuncture points. However, eight of the 63 APA members and eight of the 16 ACEP members reported training in EMDR. Further, roughly 30% of all participants responded that they use or would use bilateral stimulation (e.g., eye movements). There was a significant negative correlation between age and rating of bilateral stimulation as well as number of years since graduation and rating of bilateral stimulation. Hence, the older and/or longer out of graduate school the participant is, the less likely they would be to use techniques such as EMDR. Future research should focus on the popularity of the Power/Energy therapies with psychologists who have more recently completed their training. The present sample appears to be a reasonably representative cross-section of 58 psychologists. Because the data indicate that younger and newer graduates are more likely to be utilizing these techniques, the results of the current study may not be a completely accurate assessment of the rise in use of these techniques. In other words, these data may belie the actual upsurge in use. 4.2 Popularity of Therapies Although they tend to be older and longer out of graduate school, practitioners of psychoanalytic and psychodynamic therapies continue to comprise a significant portion of practicing psychologists. Approximately 25% of the respondents ranked the psychoanalytic/dynamic orientation as being most descriptive of themselves. Further, factor analysis of the TATQ revealed that one of three factors was clearly comprised of techniques from this orientation as well as non-directive support and promotion of self-actualization. The latter two techniques were a priori conceptualized as being from the Existential/Humanistic/Phenomenological orientation. However, neither is incongruent with analytic or dynamic theory and non-directive support is indeed a major component of its application. Additionally, it appears that relative to the other theoretical orientations, psychologists that are analytically/dynamically oriented often use techniques and approaches from their orientation and are less likely to also use techniques and approaches from other orientations. In other words, they are less technically eclectic. Cognitive-Behavioral and Eclectic theoretical orientations were the two most commonly reported as most descriptive, accounting for approximately 58% of the number one rankings. It is also interesting that 71% of respondents ranked the cognitive-behavioral orientation as first, second, or third. In other words, almost 59 three quarters of all psychologists considered themselves to be at least somewhat Cognitive-Behavioral in orientation. Only fourteen did not rank it at all. Also, a vast majority of participants reported that they use or would use most of the listed Cognitive-Behavioral techniques including cognitive restructuring and social skills training. This is regardless of described orientation. These data suggest that identification with analytic and dynamic therapies is waning and being supplanted by cognitive-behavioral treatments. Although only two of the respondents reported the Power/Energy orientation as most descriptive, the techniques from this orientation comprised another of the three factors. It is likely that so few respondents labeled Power/Energy as their primary orientation because 1) many do not practice these techniques, 2) those who do use these techniques view them as falling under or congruent with other global theoretical orientations. In other words, many practitioners who use Power/Energy techniques probably consider themselves to be Cognitive-Behavioral or Eclectic in orientation. Among users of Power/Energy therapies, EMDR and TFT appear to be the most popular. Approximately 16% of all respondents reported certification in EMDR and 8% of all respondents reported certification in TFT. However, this is probably an underestimate of the use of these therapies considering approximately 38% of respondents did not provide an answer for this non-compulsory question. Clearly, the Power/Energy therapies have impacted professional psychology. Although the results of this study do not indicate that Power/Energy therapies enjoy widespread use among practicing psychologists, because of the relationship to age, they do suggest that the impact may be growing. Further, the rise in popularity of Power/Energy 60 therapies may also be occurring largely outside of the domain of professional psychology. Many users of Power/Energy therapies may come from social work and other non-psychology fields. The empirically supported treatment movement continues to be a contentious issue. Further, the use of a variety of traditional techniques and therapies with little or no empirical support (e.g., psychoanalytic therapy) continues, but may be waning. The results of the present study are encouraging in that they do point to an increase in use of empirically supported techniques and therapies relative to the findings of previous research. Although it does not appear to be widespread, novel treatments like the Power/Energy therapies are being used by a small percentage of practicing psychologists. Additionally, the data seem to indicate that they are more popular with younger and more recently trained psychologists. Thus, both a number of empirically supported treatments (e.g., cognitive therapy) and novel unsupported treatments (e.g., TFT) appear to be gaining popularity while traditional psychotherapies (e.g., psychoanalytic psychotherapy) are being practiced less. The data from the present study indicate a relationship between critical thinking skills and therapeutic orientation. More specifically, cognitive-behavioral therapists appear to have significantly stronger ability to think critically, while therapists that employ a number of power/energy therapies appear to have a significantly weaker ability to think critically. There are a number of possible explanations for this phenomenon. One explanation is that practitioners with stronger critical thinking skills are drawn to EST’s and practitioners with weaker critical thinking skills are drawn to novel treatments, especially ones heavily marketed 61 directly to clinicians. However, this does not adequately explain the phenomenon, especially when one considers the positive correlation between the cognitivebehavioral and power/energy composite scores. There were also not significant differences on the power/energy composite scores when comparing participants by type of degree and model of their graduate programs. However, further examination is needed to evaluate the relationship between graduate training, critical, thinking skills, and practical orientation. Another more parsimonious explanation is that critical thinking skills act as a set of filters for information. The stronger the critical thinking skills the more effective the filters and the weaker the critical thinking skills the more porous the filters. Thus, the practitioner with robust filters is a skeptic and only incorporates techniques and approaches into his or her armamentarium after careful and critical examination of available data. The practitioner who filters out less is more prone to accept techniques and approaches prima facie with little or no critical examination. These latter practitioners are more vulnerable to the extensive and often savvy marketing frequently exhibited by promoters of novel treatments. In the recently published book Science and Pseudoscience in Clinical Psychology, editors Scott Lilienfeld, Steven Jay Lynn, and Jeffrey Lohr (2002) conclude the text with a “prescription” for psychology training that starts with an increased focus on critical thinking skills. The findings of this study lend further support to that assertion. A literature search on the topic of critical thinking in healthcare professions will yield literally thousands of citations from medicine and nursing and almost none from professional psychology. A concerted effort to 62 intensify critical thinking skills training in the education of professional psychologists may help to reduce the popularity of unsupported and dubious treatments. Additionally, redoubling efforts to improve psychologists’ critical thinking skills may help to encourage the use of empirically supported treatments. 4.3 Study Limitations and Recommendations for Future Research As with all mail-survey based research, a low response rate presents a limitation in the interpretation of the results. This is especially true in assessing the popularity of various treatment approaches. Another potential limitation of the study is the failure to differentiate actual use of various techniques from likelihood of use. In other words, by asking participants whether they do or would use the listed techniques, we are unable to determine actual use of the techniques. The TATQ will be improved by asking respondents to rate both actual use and likelihood of use of the listed techniques and approaches. Future research is needed to assess factors that contribute to practitioners’ choice in therapeutic technique. For example, what percentage of practitioners use cognitive restructuring because of the vast outcome literature supporting its effectiveness with a variety of problems versus other factors (e.g., heavy emphasis in graduate school, intuitive appeal, etc). Future research is also needed to assess the popularity of Power/Energy therapies in a broader range of mental health professionals. For example, it is likely that many of these treatments are popular with social workers and other master’s level clinicians not included in this study. 63 REFERENCES Adams, M.H., Whitlow, J.F., Stover, L.M., & Johnson, K.W. (1996). Critical Thinking as an Educational Outcome: An Evaluation of Current Tools of Measurement. Nurse Educator, 21, 23-32. Allison, K.W.; Echemendia, R.J.; Crawford, I.; Robinson, W. L. (1996). Predicting cultural competence: Implications for practice and training. Professional Psychology: Research & Practice, 27, 386-393. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. American Psychological Association. (2000). APA directory survey (Compiled by the Office of Demographic, Employment, and Educational Research, APA Education Directorate). Washington, DC: Author. American Psychological Association. (1993). APA directory survey (Compiled by the Office of Demographic, Employment, and Educational Research, APA Education Directorate). Washington, DC: Author. American Psychological Association. (1985). Standards for educational and psychological testing. Washington, DC: Author. Association for Comprehensive Energy Psychology. (Accessed 3-1-03). Association for Comprehensive Energy Psychology: Directory of ACEP members. Available: http://www.energypsych.org/members.cfm Bandler, R. (1985). Using your brain--for a change. Moab: Real People Press. Barlow, D.H. (1996). Health care policy, psychotherapy research, and the future of psychotherapy. American Psychologist, 51, 1050-1058. 64 Beck, A. T., Rush, A. J., Shaw, B. F. & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press. Beutler, L.E. (1998). Identifying empirically supported treatments: What if we didn't? Journal of Consulting & Clinical Psychology, 66(1), pp.113-120. Beutler, L.E. (1991). Have all won and must all have prizes? Revisiting Luborsky et al.'s verdict. Journal of Consulting & Clinical Psychology, 59, 226-232. Boychuk, J.E.D. (1999). Catching the wave: Understanding the concept of critical thinking. Journal of Advanced Nursing, 29, 577-583. Callahan, R. (1985). Five minute phobia cure. Wilmington, DE: Enterprise. Carroll, L. (1962). Alice's adventures in wonderland. Harmondsworth, Middlesex, England: Penguin Books. (Original work published 1865). Carter, C., & Gentry, J.A. (2000). Use of pop quizzes as an innovative strategy to promote critical thinking in nursing students. Nurse Educator 25, 155. Casscells, W., Schoenberger, A., & Graboys, T. (1978). Interpretation by physicians of clinical laboratory results. New England Journal of Medicine, 299, 9991001. Coan, R.W. (1979). Psychologists: Personal and theoretical pathways. New York, NY: Irvington. Cohen, J. & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates. Cohen, L.H., Sargent, M.M., & Sechrest, L.B. (1986). Use of psychotherapy research by professional psychologists. American Psychologist, 41, 198-206. 65 Commons, M.L. (2000). The Power Therapies: A proposed mechanism for their action and suggestions for future empirical validation. Electronic Journal of Traumatology, 6, Available: http://www.fsu.edu/~trauma/v6i2/v6i2a5.htm. Consumer Reports. (1995, November). Mental health: Does therapy help? 734739. Council for the National Register of Health Service Providers in Psychology. (1981). National register of health service providers in psychology. Washington, DC: Author. Council for the National Register of Health Service Providers in Psychology. (1985). National register of health service providers in psychology. Washington, DC: Author. Council for the National Register of Health Service Providers in Psychology. (1989). National register of health service providers in psychology. Washington, DC: Author. Craig, G. (Accessed 10-14-01). EFT: Emotional Freedom Techniques. A Universal Healing Aid. Available: http://www.emdr.org/general.htm. Crits-Christoph, P. (1997). Limitations of the dodo bird verdict and the role of clinical trials in psychotherapy research: Comment on Wampold et al. Psychological Bulletin, 122, 216-220. Davidson, P.R. & Parker, K.C.H. (2001). Eye Movement Desensitization and Reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316. Devilly, G.J. (2002). Eye Movement Desensitization and Reprocessing: A chronology of its development and scientific standing. Scientific Review of Mental Health Practice, 1 (2), 113-138. Diepold, J.H. (2000). Touch and Breathe: An alternative treatment approach with meridian based psychotherapies. Electronic Journal of Traumatology, 6, Available: http://www.fsu.edu/~trauma/v6i2a4.html. 66 Dineen, T. (1998). Sacred cows and straw men. American Psychologist, 53, 487488. Dobson, K.S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414-419. Dressel, P., & Mayhew, L. (1954). General Education: Exploration in Evaluation. Final Report of the Cooperative Study of Evaluation in General Education. Washington, DC: American Council on Education. EMDR International Association (Accessed 7-9-03) About EMDR. Available: http://www.emdr.org/general/index.htm. Ennis, R.H., Millman, J., & Tomko, T.N. (1985). Cornell Critical Thinking Tests Level X & Level Z Manual, 3rd Ed. Pacific Grove, CA: Critical Thinking Books and Software. Eysenck, H. J. (1952). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology, 16, 319-324. Eysenck, H. J. (1992). The effects of psychotherapy: An evaluation. Journal of Consulting & Clinical Psychology, 60, 659-663. Eysenck, H. J. (1994). Meta-analysis and its problems. British Medical Journal, 309 , 789-792. Eysenck, H. J. (1995). Meta-analysis squared--does it make sense? American Psychologist, 50, 110-111. Fiedler, K., Brinkmann, B., Betsch, T., & Wild, B. (2000). A sampling approach to biases in conditional probability judgments: Beyond base rate neglect and statistical format. Journal of Experimental Psychology: General, 129, 399-418. Fleming, T. (1999). You can heal now: The Tapas Acupressure Techniques (TAT). Redondo Beach, CA: TAT International. 67 Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore: Johns Hopkins University Press. Frye, B., Alfred, N., & Campbell, M. (1999). Use of the Watson-Glaser Critical Thinking Appraisal with BSN students. Nursing & Health Care Perspectives. 20, 253255. Gallo, F.P. (2000). Energy diagnostic and treatment methods. New York, NY: W.W. Norton & Company. Garb, H.N. (1996). The representativeness and past-behavior heuristics in clinical judgment. Professional Psychology: Research & Practice, 27, 272-277. Gaudiano, B.A. & Herbert, J.D. (2000). Can we really tap our problems away? A critical analysis of Thought Field Therapy. Skeptical Inquirer, 24, 29-33; 36. Gerbode, F. (1995). Beyond psychology: An introduction to metapsychology (3rd ed.). Palo Alto, CA: IRM Press. Gigerenzer, G., Hell, W., & Blank, H. (1988). Presentation and content: The use of base rates as a continuous variable. Journal of Experimental Psychology: Human Perception & Performance, 14, 513-525. Haas, L.J., Malouf, J.L., & Mayerson, N.H. (1988). Personal and professional characteristics as factors in psychologists' ethical decision making. Professional Psychology: Research & Practice. 19, 35-42. Halpern, D. (1998). Teaching critical thinking for transfer across domains: Dispositions, skills, structure training, and metacognitive monitoring. American Psychologist, 53, 449-455. Herbert, J.D. (2003). Introduction to the special series on empirically supported treatments. Behavior Modification, 27 (3), 287-289. 68 Herbert, J.D. (2000). Defining empirically supported treatments: Pitfalls and possible solutions. Behavior Therapist, 23 (6), 113-122, 134. Herbert, J.D., Lilienfeld, S.O., Lohr, J.M., Montgomery, R.W., O'Donohue, W.T., Rosen, G.M., & Tolin, D.F. (2000). Science and pseudoscience in the development of eye movement desensitization and reprocessing: Implications for clinical psychology. Clinical Psychology Review, 20, 945-971. Herbert, J.D. (in press). Eye movements, neurobabble, and dubious psychotherapy. Review of Light in the Heart of Darkness: EMDR and the treatment of war and terrorism survivors. Contemporary Psychology. Hill, C.E. & Corbett, M.M. (1993). A perspective on the history of process and outcome research in counseling psychology. Journal of Counseling Psychology, 40, 3-24. Holland, J. L. (1986). Student selection, training, and research performance. The Counseling Psychologist, 14, 121-126. Howard, G.S. (1993). I think I can! I think I can! Reconsidering the place for practice methodologies in psychological research. Professional Psychology: Research and Practice, 24, 237-244. Hunsley, J. & DiGiulio, G. (2002). Dodo bird, phoenix, or urban legend? The question of psychotherapy equivalence. Scientific Review of Mental Health Practice, 1, 11-22. Jensen, J.P. & Bergin, A.E. (1988). Mental health values of professional therapists: A national interdisciplinary survey. Professional Psychology: Research & Practice, 19, 290-297. Jensen, J.P., Bergin, A.E., & Greaves, D.W. (1990). The meaning of eclecticism: New survey and analysis of components. Professional Psychology: Research & Practice, 25, 124-130. 69 Johnson, M.E. & Brems, C. (1991). Comparing theoretical orientations of counseling and clinical psychologists: An objective approach. Professional Psychology: Research & Practice, 22, 133-137. Johnson, M.E., Campbell, J.L., & Masters, M.A. (1992). Relationship between family-of-origin dynamics and a psychologist's theoretical orientation. Professional Psychology: Research & Practice, 23, 119-122. Kahneman, D., Slovic, P. & Tversky, A. (1982). Judgment under uncertainty: Heuristics and biases. Cambridge, England: Cambridge University Press. Kalal, D.M. (1999). Critical thinking in clinical practice: Pseudoscience, fad psychology, and the behavioral therapist. The Behavior Therapist, 22, 81-84. Klaczynski, P.A., Gordon, D.H., and Fauth, J. (1997). Goal-oriented critical reasoning and individual differences in critical reasoning biases. Journal of Educational Psychology, 89, 470-485. Lafferty, P., Beutler, L.E. Crago, M. (1989). Differences between more and less effective psychotherapists: A study of select therapist variables. Journal of Consulting & Clinical Psychology, 57, 76-80. Lazarus, A.A & Beutler, L. E. (1993). On technical eclecticism. Journal of Counseling and Development, 71, 381-385. Lazarus, A.A. (2000). Will reason prevail? From classic psychoanalysis to new age therapy. American Journal of Psychotherapy, 54, 152-155. Levy, C.H. (1984). The metamorphosis of clinical psychology: Toward a new charter as human services psychology. American Psychologist, 39, 486-494. Levy, D.A. (1997). Tools of critical thinking: Metathoughts for psychology. Boston, MA: Allyn and Bacon. Lilienfeld, S.O., Lynn, S.J., & Lohr, J.M. (2002). Science and Pseudoscience in clinical psychology. Atlanta, GA: Guilford Press. 70 Lipsey, M.W. & Wilson, D.B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181-1209. Lohr, J.M., Tolin, D.F., & Lilienfeld, S.O. (1998). Efficacy of eye movement desensitization and reprocessing. Implications for behavior therapy. Behavior Therapy, 29, 123-156. Luborsky, L., Singer, B. & Luborsky, L. (1975). Comparative studies of psychotherapies. Archives of General Psychiatry, 32, 995-1008. Matthews, C.H. & Marshall, L.L. (1988). Self-monitoring and intake interviewers' therapeutic orientations. Professional Psychology: Research & Practice, 19, 433-435. Milan, M.A., Montgomery, R.W., & Rogers, E.C. (1994). Theoretical orientation revolution in clinical psychology: Fact or fiction? Professional Psychology: Research & Practice, 25, 398-402. Mintz, J., Drake, R.E. & Crits-Christoph, P. (1996). Efficacy and effectiveness of psychotherapy: Two paradigms, one science. American Psychologist, 51, 1084-1085. Modjeski, R.B. & Michael, W.B. (1983). An evaluation by a panel of psychologists of the reliability and validity of two tests of critical thinking. Educational and Psychological Measurement, 43, 1187-1197. Myers, D.G. (1996). Social psychology (5th ed.). New York, NY: McGraw-Hill. Nims, L.P. (Accessed 10-14-01). Be Set Free Fast. Available: http://www.besetfreefast.com/. Paul, G.L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting Psychology, 31, 109-118. Polusny, M.A. & Follette, V. M. (1996). Remembering childhood sexual abuse: A national survey of psychologists' clinical practices, beliefs, and personal experiences. Professional Psychology: Research & Practice, 27, 41-52. 71 Roe, C.A. (1999). Critical thinking and belief in the paranormal: A re-evaluation. British Journal of Psychology, 90, 85-98. Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103. Rosen, G.M., Lohr, J.M., McNally, R.J., & Herbert, J.D. (1998). Power therapies, miraculous claims, and the cures that fail. Behavioural and Cognitive Psychotherapy, 26, 97-99. Rosen, G.M., Lohr, J.M., McNally, R.J., & Herbert, J.D. (1999). Power therapies: Evidence vs. miraculous claims. Behavioural and Cognitive Psychotherapy, 27, 9-12. Rosenzweig, S. (1936). Some implicit common factors in diverse methods in psychotherapy. American Journal of Orthopsychiatry, 6, 412-415. Sa, W.C., West, R.F., & Stanovich, K.E. (1999). The domain specificity and generality of belief bias: Searching for a generalizable critical thinking skill. Journal of Educational Psychology. 91, 497-510. Sammons, M.T. & Gravitz, M.A. (1990). Theoretical orientations of professional psychologists and their former professors. Professional Psychology: Research and Practice, 21, 131-134. Scandell, D.J., Wlazelek, B.G., & Scandell, R.S. (1997). Personality of the therapist and theoretical orientation. The Irish Journal of Psychology, 18, 413-418. Schafer, P.J. (1974). Critical thinking ability of teachers. Journal of Instructional Psychology, 1, 39-40. Scott, J.N. & Markert, R.J. (1994). Relationship between critical thinking skills and success in preclinical courses. Academic Medicine, 69, 920-924. Seligman, M.E.P. (1995). The effectiveness of psychotherapy. The Consumer Reports study. American Psychologist, 50, 965-974. 72 Shadish, W.R. & Sweeney, R.B. (1991). Mediators and moderators in metaanalysis: There's a reason we don't let dodo birds tell us which psychotherapies should have prizes. Journal of Consulting & Clinical Psychology, 59, 883-893. Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic protocols, principles, and procedures. New York, NY: Guilford. Singer, M.T., & Lalich, J. (1996). “Crazy” therapies: What are they? Do they work? San Francisco, CA: Jossey-Bass Publishers. Smith, J., Staudinger, U.M., & Baltes, P.B. (1994). Occupational settings facilitating wisdom-related knowledge: The sample case of clinical psychologists. Journal of Consulting & Clinical Psychology, 62, 989-999. Smith, M.L., Glass, G.V. & Miller, T.L. (1980). The benefits of psychotherapy. Baltimore, MD: Johns Hopkins University Press. Sormunen, C. & Chalupa, M. (1994). Critical thinking skills research: Developing evaluation techniques. Journal of Education for Business, 69, 172-177. Stanovich, K.E. (2001). How to think straight about psychology (6th ed.). New York, NY: HarperCollins Publishers. Stanovich, K. E., & West, R.F. (1997). Reasoning independently of prior belief and individual differences in actively open-minded thinking. Journal of Educational Psychology, 89(2) pp. 342-357. Stanovich, K. E., & West, R.F. (1998). Individual Differences in rational thought. Journal of Experimental Psychology: General, 127, 161-188. Task Force on Promotion and Dissemination of Psychological Procedures. (1995). Training in and dissemination of empirically-validated psychological procedures: Report and recommendations. The Clinical Psychologist, 48 (1), 3—23. Thought Field Therapy Training Center of La Jolla (Accessed 10-14-01). About thought field therapy. Available: http://www.thoughtfield.com/about.htm. 73 Tinsley, D.J., Tinsley, H.E., Boone, S., & Shim-Li, C. (1993). Prediction of scientist-practitioner behavior using personality scores obtained during graduate school. Journal of Counseling Psychology, 40, 511-517. TFTRX. (Accessed 9-29-01). What is the Callahan Techniques® Thought Field Therapy (TFT)? Available: http://www.tftrx.com/alternative_medicine.htm. Wampold, B.E., Mondin, G.W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, "all must have prizes." Psychological Bulletin, 122, 203-215. Watson, G., & Glaser, E. M. (1980). Watson-Glaser Critical Thinking AppraisalManual Forms A and B. San Antonio, TX: Psychological Corporation. Watson, G., & Glaser, E. M. (1994). Watson-Glaser Critical Thinking AppraisalManual Form S. San Antonio, TX: Psychological Corporation. White, K.P. (2000). Psychology and complementary and alternative medicine. Professional Psychology: Research & Practice, 31, 671-681. Zook, A. & Walton, J.M. (1989). Theoretical orientations and work settings of clinical and counseling psychologists: A current perspective. Professional Psychology: Research & Practice, 20, 23-31. 74 Appendix A: Demographic Information Gender: 1. Male: _____ 2. Female: _____ Age: ______ Racial or Ethnic Group: ______________________________ Highest degree currently held: 1. M.A./M.S./M.Ed 2. Ph.D. 3. Ed.D. 5. Other, please specify__________________ 4. Psy.D. Certifications/Additional Training (e.g., EMDR Level II, ABPP, TFTdx, Post-doc) __________________________________________________________________________________ __________________________________________________________________________________ Years since graduation from highest degree: ______________ Years of experience as a therapist/clinician: ______________ How many hours a week (on average) do you spend providing therapy or counseling: ______ Work Setting Please indicate your main work setting. If you work in more than one of the settings please rank order them according to time. For example, if you spend 3 days a week in private practice, 1 day a week at a hospital, and a half day teaching you would rank them 1, 2, and 3, respectively. 1. _____Independent practice (i.e., individual or group private practices, industry, and/or consultation) 2. _____Agency (i.e., college or university counseling center, community mental health center [CMHC], Veterans Administration [VA], psychiatric hospital, general hospital, other medical and/or rehabilitation center, and other mental health agency) 3. _____Academic (i.e., non-clinical university and medical school faculty, research positions) Model of your graduate program: 1. Professional (practitioner-scholar)__________ 2. 3. Professional-scientist (practitioner-scientist)__________ Scientist-practitioner (Boulder model)__________ Theoretical Orientation Please rank order your theoretical orientation(s) with 1 being the orientation that most closely describes you. Please rank order only the orientation(s) that you consider descriptive of yourself. Systems/Family Systems_______ Cognitive-Behavioral_______ Psychoanalytic/Dynamic_______ Power/Energy_______ Existential/Humanistic/Phenomenological_______ Radical Behavioral/Applied Behavior Analytic_______ Eclectic_______ What was the predominant orientation(s) of your training program?____________________________ 75 Appendix B: CTQ Correct answers are in bold. Participant # _____________ Please do not put your name on the questionnaire. We are interested in the thinking styles of psychologists. Please complete the following questions as best you can. Remember that all responses are completely confidential. Please try to complete the questions all at one sitting, do not spend too much time on any one question, and do not use help from others or other sources. Instructions are provided for some of the exercises. Please make sure that all answers are clearly marked. Thanks again for your participation! Exercise 1 Imagine that disorder X occurs in one in every 1,000 people. Imagine also there is a test to diagnose the disorder that always gives a positive result when a person has the disorder. Finally, imagine that the test has a false positive rate of 5 percent. This means that the test wrongly indicates that the disorder is present in 5 percent of the cases where the person does not have the disorder. Imagine that we choose a person randomly, administer the test, and that it yields a positive result (indicates that the person has the disorder). What is the probability that the individual actually has the disorder, assuming that we know nothing else about the individual's psychological or medical history? A) < 10% B) 10-30% C) 30-50% D) 50-70% E) 70-90% F) >90% Exercise 2 The next exercises consist of brief paragraphs followed by several conclusions. For these questions please assume that everything in the paragraph is true. The problem is to judge whether or not each of the proposed conclusions logically follows beyond a reasonable doubt from the information given. Please mark either follows or does not follow after the conclusion. Chris had poor posture, had very few friends, was ill at ease around people, and in general was very unhappy. Then, a close friend recommended that Chris visit Dr. Carll, a reputed expert on helping people improve their personalities. Chris took this recommendation and, after three months of therapy with Dr. Carll, developed more friendships, was more at ease, and in general felt happier. 2. Without Dr. Carll’s therapy, Chris would not have improved. A) Follows B) Does Not Follow 76 3. Without a friend’s advice, Chris would not have heard of Dr. Carll. A) Follows B) Does Not Follow When I go to bed at night, I usually fall asleep quite promptly. But about twice a month I drink coffee during the evening, and whenever I do, I lie awake and toss for hours. 4. My problem is mostly psychological; I expect that the coffee will keep me awake and therefore it does. A) Follows B) Does Not Follow 5. On nights when I want to fall asleep promptly, I’d better not drink coffee in the evening. A) Follows B) Does Not Follow When the Journal Company, Inc. was created in 1960, it was the largest psychological journal company America had known up to that time. It produced twice as many psychological journals as all of its domestic competitors put together. Today, the Journal Company, Inc. produces about 20 percent of the psychological journals that are made in this country. 6. In 1960, the Journal Company, Inc. produced not less than 66 percent of the total domestic output of psychological journals. A) Follows B) Does Not Follow 7. Today, domestic competitors produce more than three times as many psychological journals as does the Journal Company, Inc. A) Follows B) Does Not Follow 8. The Journal Company, Inc. produces fewer psychological journals then it did in 1960. A) Follows B) Does Not Follow Exercise 3 In this section, each exercise consists of several statements followed by several suggested conclusions. For the purposes of this study, consider the statements in each exercise as true without exception. After reading the conclusion beneath the statement, please mark whether you think it FOLLOWS or DOES NOT FOLLOW from the statement given, regardless of whether you believe the statement to be true or not from your own experience or knowledge. No person who thinks scientifically places any faith in the predictions of astrologers. Nevertheless, there are many people who rely on horoscopes provided by astrologers. Therefore – 77 9. People who lack confidence in horoscopes think scientifically. A) Follows B) Does Not Follow 10. Many people do not think scientifically. A) Follows B) Does Not Follow Most persons who attempt to break their smoking habit find that it is something that they can accomplish only with difficulty, or cannot accomplish at all. Nevertheless, there is a growing number of individuals whose strong desire to stop smoking has enabled them to break the habit permanently. Therefore – 11. Only smokers who strongly desire to stop smoking will succeed in doing so. A) Follows B) Does Not Follow 12. A strong desire to stop smoking helps some people to permanently break the habit. A) Follows B) Does Not Follow Exercise 4 Below are several statements followed by several proposed assumptions. You are to decide for each assumption whether a person, in making the given statement, is really making that assumption. If you think that the given assumption is taken for granted in the statement, chose Assumption Made. If you think the assumption is not necessarily taken for granted in the statement, chose Assumption Not Made. Statement: “I’m traveling to South America for a psychological conference. I want to be sure that I do not get typhoid fever, so I shall go to my physician and get vaccinated against typhoid fever before I begin my trip.” Proposed assumptions: 13. If I don’t take the injection, I shall become ill with the fever. A) Assumption made B) Assumption not made 14. By getting vaccinated against typhoid fever, I decrease the chances that I will get the disease. A) Assumption made B) Assumption not made 15. Typhoid fever is more common in South America than it is where I live. A) Assumption made B) Assumption not made For the next questions, someone is speaking; but in each case there is an unstated assumption. Again, an assumption is a statement that is taken for granted. From the choices that follow, select the one (A, B, or C) that is most probably the unstated assumption. Consider each item by itself. 78 16. Statement: The fact that Bridgetown’s children have been forced to work explains their misbehavior. A) Children who have never been forced to work behave properly. B) Children who behave improperly have been forced to work. C) Children who have been forced to work behave improperly 17. Statement: What we should do is not make them work. Then they will be all right. I know it. A) Children who are forced to work will misbehave. B) Children who are not forced to work will behave properly. C) Children who behave properly have not been forced to work. 18. Statement: The explanation of the misbehavior of Bridgetown’s presentday crop of youngsters is a simple one. These children have been severely punished at some time or other. That’s the trouble. A) Children who have been severely punished misbehave. B) Children who misbehave have been severely punished at some time. C) Children who haven’t been severely punished behave properly. 19. Statement: What we should do is never punish them. That would take care of things. A) Children who behave badly have been punished at some time. B) Children who are punished will misbehave. C) Children who behave properly have never been punished. Exercise 5 Below are several questions followed by several arguments. For the purpose of this study, please regard each argument as true. The problem then is to decide whether it is a strong (it is important and directly related to the question) or weak (not directly related to the question or related only to trivial aspects) argument. Remember that each argument is to be regarded as true. Question: Should the United States Department of Health and Human Services keep the public informed of its anticipated scientific research programs by publicizing ahead of time the needs that would be served by each program? 20. No; some become critical of the government when widely publicized projects turn out unsuccessfully. A) Strong argument B) Weak argument 79 21. Yes; only a public so informed will support vital research and development activities with its tax dollars. A) Strong argument B) Weak argument Question: Do juries decide court cases fairly when one of the opposing parties is rich and the other is poor? 22. No; because rich people are more likely to settle their court cases. A). Strong argument B) Weak argument 23. No; most jurors are more sympathetic to poor people than to the rich, and the jurors sympathies affect their findings. A). Strong argument B) Weak argument 24. No; because rich people can afford to hire better lawyers than poor people, and juries are influenced by the skill of the opposing lawyers. A). Strong argument B) Weak argument Question: Should pupils be excused from public schools to receive religious instruction in their own churches during school hours? 25. No; having public school children go off to their separate churches during school hours would seriously interfere with the educational process and create friction among children of different religions. A). Strong argument B) Weak argument 26. No; religious instruction during school hours would violate our constitutional separation of church and state; those who desire such instruction are free to get it after school hours. A). Strong argument B) Weak argument 27. The table below summarizes data from an experiment. Based on the data, please rate the degree of effectiveness of the treatment on the scale below. Improvement Treatment 200 No Treatment 50 No Improvement 75 15 A) not at all effective B) somewhat effective C) effective D) very effective 28. If the above table was an accurate reflection of the effectiveness of an innovative new treatment, how likely would you be to use it? A) would not use definitely use B) would possibly use C) would probably use D) would 80 Appendix C: Critical Thinking Questionnaire (CTQ) Item Sources Inference Question 1: Non-causal base rate problem adapted from Stanovich (2001) who adapted it from (Casscells, Schoenberger, & Graboys, 1978). Question 27-28: Adapted from Stanovich (2001). Interpretation Question 2-8: Adapted from the interpretation section of the WGCTA- Form S (Watson & Glaser, 1994). Deduction Questions 9-12: Adapted from the deduction section of the WGCTA- Form S (Watson & Glaser, 1994). Recognition of Assumptions Questions 13-15: Adapted from the recognition of assumptions section of the WGCTA- Form S (Watson & Glaser, 1994). Questions 16-19: Adapted from Section VII of the CCTT-Z and represent both the recognition of assumptions and deduction subcategories (Ennis, Millman, & Tomko, 1985). Evaluation of Arguments Questions 20-26: Adapted from the evaluation of arguments section of the WGCTAForm S (Watson & Glaser, 1994). 81 Appendix D: Treatment Approaches and Techniques Questionnaire (TATQ) This is a list of non-mutually exclusive treatment approaches/techniques. Using the scale below, please indicate your utilization of each of the items in your clinical work. 0 = Never use/Would not use 1 = Sometimes use/Would possibly use 2 = Frequently use/Would probably use 3 = Almost always use/Would definitely use ___muscle-testing/applied kinesiology ___shaping ___analysis/interpretation of transference ___family mapping ___time delay prompting ___enactments ___touch and breath ___free association ___bilateral stimulation (e.g., eye movements) ___avoidance of loss contingency ___cognitive restructuring ___required relaxation ___genogram work ___homework/behavioral experiments ___body-energy work ___mirroring ___exposure exercises ___unconditional positive regard ___non-directive support ___experiments in directed awareness ___family reconstruction ___self-modeling ___tapping of acupressure/acupuncture points ___stimulation of energy meridians ___breathing retraining ___relaxation methods ___maintenance of analytic framework ___promotion of self-actualization ___social skills training ___family sculpting ___dream analysis ___analysis/interpretation of resistances ___ego strengthening ___token economy ___logotherapy ___re-authoring 82 Appendix E: TATQ Items S/FS-systems/family systems; C-B-cognitive-behavioral; A/D-analytic/dynamic; P/Epower/energy; E/H/P-existential/humanistic/phenomenological; RB/ABA-radical behavioral/applied behavior analysis This is a list of non-mutually exclusive treatment approaches/techniques. Using the scale below, please indicate your utilization of each of the items in your clinical work. 0 = Never use/Would not use 1 = Sometimes use/Would possibly use 2 = Frequently use/Would probably use 3 = Almost always use/Would definitely use 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. ___tapping of acupressure/acupuncture points (P/E1)2. ___bilateral stimulation (e.g., eye movements) (P/E2) ___stimulation of energy meridians (P/E3) ___muscle-testing/applied kinesiology (P/E4) ___body-energy work (P/E5) ___touch and breath (P/E6) ___unconditional positive regard (E/H/P1) ___non-directive support(E/H/P2) ___mirroring (E/H/P3) ___experiments in directed awareness (E/H/P4) ___promotion of self-actualization (E/H/P5) ___logotherapy (E/H/P6) ___free association (A/D1) ___dream analysis (A/D2) ___analysis/interpretation of resistances (A/D3) ___analysis/interpretation of transference (A/D4) ___maintenance of analytic framework (A/D5) ___ego strengthening (A/D6) ___cognitive restructuring (C-B1) ___social skills training (C-B2) ___breathing retraining (C/B3) ___homework/behavioral experiments (C/B4) ___relaxation methods (C/B5) ___exposure exercises (C/B6) ___token economy (RB/ABA1) ___avoidance of loss contingency (RB/ABA2) ___required relaxation (RB/ABA3) ___self-modeling (RB/ABA4) ___shaping (RB/ABA5) ___time delay prompting (RB/ABA6) ___genogram work (S/FS1) ___family sculpting (S/FS2) ___family reconstruction (S/FS3) ___family mapping (S/FS4) ___enactments (S/FS 5) 36. ___re-authoring (S/FS 6 83 VITA Ian Randolph Sharp was born in Bridgeton, NJ on March 14, 1974 and moved to Pennsylvania at the age of 10. He received his Bachelor of Arts in psychology from Randolph-Macon College in 1996. Following undergraduate training, he was a research assistant at the Commonwealth Institute for Child and Family Studies at the Medical College of Virginia under the direction of Nirbhay N. Singh, Ph.D. He received a Master of Arts in clinical psychology from MCP Hahnemann University in 2000. At MCPHU and then Drexel University, he worked in the lab of mentor James D. Herbert, Ph.D. whose primary research focused on the study and treatment of social anxiety disorder. During his Ph.D. training, Ian had opportunities to teach undergraduate courses in general psychology at Drexel University and statistics at Penn State-Abington College. In August 2003, he completed his predoctoral internship at the Devereux Kanner Center, a residential treatment facility for persons with dual diagnosis. Following internship, he accepted a postdoctoral research fellowship with Aaron T. Beck, M.D. in the Psychopathology Research Unit at the University of Pennsylvania.